experienced the past few decades The increasing concentration of hospitals and other healthcare services in the United States of America. in 2005, About half of US hospitals It was part of a larger system. By 2017, it was two-thirds. Most places in the United States have what is considered a highly concentrated hospital market, which means that one company operates most of the hospital facilities in the area.
This focus is one of the most important trends in American healthcare. It can lead to fewer options for patients and higher prices. Recent research has been found Rising hospital prices have been driving much of the recent increases in health care spending in the United States. Hospitals acquired by larger systems sometimes interrupt important services, Like maternity careThis forces patients to travel for hours to receive medical services they used to get locally.
like I wrote late last yearAmerica’s smaller community hospitals, many of which are operating in short supply, often have to explore mergers with larger health systems to keep the doors open.
Rising costs are bad news for patients. But it is notoriously difficult to analyze the clinical consequences of such mergers: Does a more focused hospital system also lead to worse care? There are many variables in the game, and mergers can disrupt the healthcare market (through those higher prices) in ways that make it difficult to isolate how any post-merger hospital operations changes contributed to any increase in deaths or readmissions.
A new study of hospital mergers in the UK attempts to shed light on this question. It found that after hospitals merged, patients were more likely to die during or shortly after a hospital stay and more likely to be readmitted again in the near term, according to New search Scholars at Cornell University and the University of London. The researchers found that these increases begin within a few months of consolidation and last for at least two years.
Most UK hospitals are publicly owned, but the national government still is Make integration a priority In order to improve the performance of its health system by merging financially struggling hospitals with another hospital. In practice, a British hospital merger often looks similar to an American hospital merger: separate facilities that previously operated under separate management are under the authority of a single board of directors and a single senior leadership team.
The magnitude of the effect of mergers, especially on mortality, is significant: the likelihood of a patient dying in hospital or within 30 days of discharge from hospital increased by 0.4 percentage points, an increase of 27 percent from the pre-merger mortality rate of 1.4 percent. They are also more likely to be readmitted, by 11 percent, within 30 days of being discharged from the hospital.
In the 139 hospitals involved in 13 different mergers from 2006 to 2015, this increase in deaths and readmissions translated into 60 additional deaths and 140 readmissions compared to a large control group of UK hospitals that did not experience a merger over that period.
“Mergers and acquisitions raise a number of antitrust concerns, chief among them that market consolidation may lead to higher prices or poorer product quality,” the authors, Elena Ashtari Tafti of University College London and Thomas Ho of Cornell University, write to open their conclusions. “Both of these effects are very important in healthcare markets, which have seen significant consolidation activity over the past two decades, and where pricing and quality can be a matter of life and death.”
In the United States, the evidence on how mergers affect the quality of care is limited and mixed. But the UK and its National Health Service are arguably the perfect place to study these effects, the authors argue, because payment and the mix of taxpayers do not change as a result of the merger. This removes one variable that could confuse similar research in the United States. They studied the period from 2006 to 2015 in part because NHS reforms followed It gave patients more choices about where to seek care and set hospitals with a fixed budget for their operations.
Ashtari Tafti and Howie describe this particular feature of the UK health system as a virtue of their research. They also noted that their findings are a logical extension of previous studies that found that quality of care was better in more competitive hospital markets. But they acknowledged that more work needed to be done to determine whether the results would be replicated in a different health system with a different payment structure, such as the United States.
I asked Hannah Neberach, a health care economist at the University of Minnesota, who did not contribute to the research, if she thought what the UK researchers had discovered would be applicable in the United States. She noted that the study sample was rather small (13 mergers affected 139 acute care hospitals; for example, the UK control group included about 1,100 hospitals and the US had about 5,000 similar facilities). It also pointed out some specific findings (such as a particularly large increase in kidney-related deaths) that warranted further scrutiny and explanation, and the authors noted that specific changes in post-merger hospital operations affecting clinical quality should be the subject of future investigation.
“For me, there’s a lingering question of generalizability, but it’s not really because of the differences between the US and UK hospital,” she said.
Patients in the United States already Report Worse experience when treating in hospitals that have gone through a merger. This new research indicates that there is also a measurable effect on the objective quality of care they receive.
The US health system, given its perverse financial incentives, has prompted more and more hospitals to merge together in an effort to stay open, operate more efficiently, and in theory better coordinate services for their patients. Federal regulators have sometimes tried to stop these mergers, but they haven’t Face different obstacles and restrictions. Hospitals have it in the meantime Making the case that consolidation actually benefits patients — with little empirical evidence to the contrary — to justify these mergers with government officials.
But the ongoing concern is that the quality of care could deteriorate if hospitals face less competition. What Ashtari Tafti and Hoy saw in their research suggests that these concerns need to be taken seriously as regulators review future mergers and acquisitions.