Hospital Consolidation

Hospital consolidation has increased rapidly since 2010. Many studies have shown an increase in prices for commercially insured patients, but what about the quality of care? The New England Journal of Medicine came to the conclusion that quality of care has not improved. In their study, they compare acquired hospitals’ quality of care before the merger and after. These results were then compared to that of control hospitals, facilities that were not merged with any others.

Getting Less for More

While we believe more expensive care to be of higher quality, this is not so. J. Michael McWilliams of Harvard posed the question, “what are we getting from higher hospital prices?” He points out how these prices have stunted growth in U.S. health spending. Harvard Medical and Business Schools studied almost 250 hospital mergers between 2009 and 2013. One factor? Whether or not patients would recommend the care from one of these hospitals to others. Results showed the merging of hospitals didn’t help the quality of care, it has even gone down in some cases. While there wasn’t a study for the reasoning behind the negative results, it’s worth noting the spread of low-quality care. The mergers seem to have spread low quality while ceasing the existence of high-quality care. A more isolated study may have gotten different results, but only measurable aspects of quality were usable in this study.

Hospital Consolidation: A Brief History

There was a brief hospital merger in the 1990s, mainly due to revenue restraints on providers. Insurance companies and hospitals were battling one another over the prices of medical care. At the time, policymakers also failed to realize the danger of hospital monopolies. Monopolization is not a factor in the current consolidations, even though pricing seems to be one of the biggest concerns. However, Nancy Beaulieu of the Harvard team admits, “we can’t rule out the possibility that some mergers are good for patient care.” Still, she believes it’s right to reconsider hospital consolidation. Studies analyze 30-day readmission and mortality rates among discharged patients as well. It’s important to know the mortality rates did not experience significant changes. Hospital mergers are not exactly hurting patients, but they may not be doing as much as we once hoped. One possibility behind the change is that there are fewer hospitals to compete with when they’ve been combined. It doesn’t seem that any of the hospitals are pushing their good qualities onto the hospitals they acquire. If none of them pick up good habits, the mergers may be a complete failure.

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