Unbiased Analysis of Today's Healthcare Issues
The answer to this question likely will be shaped in part by a new multilateral working group that will include not only representatives from the U.S. (U.S. Department of Justice Antitrust Division, and Offices of State Attorneys General), but also Canada (Canadian Competition Bureau), Europe (the European Commission Directorate General for Competition) and the United…
As COVID-19 has made many of us acutely aware, providing high quality mental health care is vital. However, the mental health care market is a difficult one for insurers; there is evidence that uncertainty and variation in treatments are greater compared to physical health conditions (for instance, see Frank et al. 2000). Thus uncertainty and…
Health systems have been touted by some to be a cure to many of our health care systems ills by providing integrated, high quality care. Others claim that health systems are just a way for providers to big up prices through more bargaining power. Either way, it is not entirely clear to what extent health…
Last week I reviewed an article on some of the potential positives and negatives of large, integrated health systems. A recent 60 Minutes episode talks about some of the perils by examining how Sutter health system has become a near monopoly provider in Northern California. Consider the following interaction between Leslie Stahl of 60 minutes…
Integrated delivery networks. IDNs. Accountable Care Organizations. ACOs. Systems of care. Health systems. Whatever you call them, many health policy experts claim that they are the best way for the U.S. health care system to deliver high quality care in a cost-effective manner. But is that really the case? A commentary by UCSD professor and…
Physicians are increasingly becoming parts of larger and larger practice. Further, many physicians are shifting from firm owners to employees. In recent years, private equity investments have helped to accelerate this trend. A paper by Brusch et al. (2020) reviews this trend among women’s health practices (i.e., o bstetrics/gynecology (OB/GYN) or fertility services). They look…
Are narrow networks a good thing? On the one hand, they may be able to reduce health insurance premiums if insurers can negotiate lower prices. On the other hand, narrow networks means less choice of providers for patients. An less well-understood question is how narrow networks affect health care costs and utilization. Empirically, broader networks…
One trend in recent years is how many hospitals are being purchased by large regional or national hospital chains. An April 2019 slide deck from the NIHCM Foundation shows this trend graphically. A paper by Hsieh and Rossi-Hansberg (2019) provide some aggregate data as well as a case study from the Boston area. Four decades…
The National Institute for Health Care Management (NIHCM) has some nice slides describing trends in hospital consolidation. First, we see a trend of increased hospitalizations over time. Further, these mergers are not small. In 49% of cases, the acquired (i.e., smaller) hospital has revenue of >$100m and in 19% of cases the acquired hospitals has…
Yesterday, I discussed the idea of managed competition in California. One of the original tenets of managed competition was insurers having integrated, mutually exclusive provider networks. This would mean much more consolidation on the provider side. While this could improve quality, there is also a risk that prices could rise. In fact, this is what…