Hospitals, Market Share, and Consolidation
Hospitals, Market Share, and Consolidation
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DOI：
10.1001/jama.2013.281675
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发表时间：
2013-11-13
影响因子：
120.7
通讯作者：
Morton, Fiona Scott
中科院分区：
文献类型：
--
作者：
Cutler, David M.;Morton, Fiona Scott
住院治疗使用的大幅减少，加上《平价医疗法案》中的激励措施，正在导致医院行业的重大整合。曾经是一组独立的医院，与提供门诊护理的医生和临床医生保持着一定的距离，现在正在成为少数地方综合卫生系统，通常围绕着著名的大型学术医疗中心建立。在美国，典型的地区有3到5个统一的卫生系统，涵盖了广泛的护理环境，在这些系统之外还有较小的边缘卫生保健中心。综合卫生系统有优点也有缺点。其优点包括能够协调不同的从业人员和护理地点的护理。与此相抵消的是，市场力量增强可能导致价格上涨。因为保险公司很难与仅有的几个医疗系统中的一个成功讨价还价，所以市场力量会增强。反垄断当局正在审查这些合并系统的形成，但很难得出广泛的结论，因为通常情况下，一个系统的创建将产生利益和损害，每组事实将是不同的。此外，反垄断当局在造成净损害的情况下传统上使用的补救措施（例如，阻止交易或要求各方剥离资产）是有限的。出于这个原因，地方政府可能想要引入新的政策，以确保消费者在合并的情况下获得保护，比如向高价的临床医生和医疗保健中心收取更多的保险产品，向临床医生和医疗保健组织捆绑付款，以消除大型机构提供更多护理的动机，并建立特定地区的价格或支出目标。
A large reduction in use of inpatient care combined with the incentives in the Affordable Care Act is leading to significant consolidation in the hospital industry. What was once a set of independent hospitals having arms-length relationships with physicians and clinicians who provide ambulatory care is becoming a small number of locally integrated health systems, generally built around large, prestigious academic medical centers. The typical region in the United States has 3 to 5 consolidated health systems, spanning a wide range of care settings, and a smaller fringe of health care centers outside those systems. Consolidated health systems have advantages and drawbacks. The advantages include the ability to coordinate care across different practitioners and sites of care. Offsetting this is the potential for higher prices resulting from greater market power. Market power increases because it is difficult for insurers to bargain successfully with one of only a few health systems. Antitrust authorities are examining these consolidated systems as they form, but broad conclusions are difficult to draw because typically the creation of a system will generate both benefit and harm and each set of facts will be different. Moreover, the remedies traditionally used (eg, blocking the transaction or requiring that the parties divest assets) by antitrust authorities in cases of net harm are limited. For this reason, local governments may want to introduce new policies that help ensure consumers gain protection in the event of consolidation, such as insurance products that charge consumers more for high-priced clinicians and health care centers, bundling payments to clinicians and health care organizations to eliminate the incentives of big institutions to simply provide more care, and establishing area-specific price or spending targets.