Health Care Market Concentration Trends In The United States: Evidence And Policy Responses
Health Care Market Concentration Trends In The United States: Evidence And Policy Responses
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DOI：
10.1377/hlthaff.2017.0556
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发表时间：
2017-09-01
期刊：
影响因子：
9.7
通讯作者：
Fulton, Brent D.
中科院分区：
文献类型：
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作者：
Fulton, Brent D.
决策者和分析人士一直对医疗保健提供者和医疗保险公司在全国市场的日益集中表示关切，包括对医疗保健成本和质量的潜在不利影响。美国经济顾问委员会（Council of Economic Advisers）最近表达了对美国经济许多领域缺乏市场集中度估算的担忧。为了解决医疗保健领域的这一差距，本研究分析了2010年至2016年美国医院、医生组织和医疗保险公司的市场集中度趋势。医院和医生组织市场在这一时期变得越来越集中。初级保健医生的集中度增加最多，部分原因是医院和卫生保健系统收购了初级保健医生组织。2016年，90%的都市统计区（msa）高度集中于医院，65%集中于专科医生，39%集中于初级保健医生，57%集中于保险公司。分析的346种msa中有91%可能值得关注和审查，因为它们在2016年的浓度水平以及自2010年以来浓度的变化。加强竞争的公共政策是必要的，例如更严格地执行反垄断法，降低进入壁垒，限制反竞争行为。
Policy makers and analysts have been voicing concerns about the increasing concentration of health care providers and health insurers in markets nationwide, including the potential adverse effect on the cost and quality of health care. The Council of Economic Advisers recently expressed its concern about the lack of estimates of market concentration in many sectors of the US economy. To address this gap in health care, this study analyzed market concentration trends in the United States from 2010 to 2016 for hospitals, physician organizations, and health insurers. Hospital and physician organization markets became increasingly concentrated over this time period. Concentration among primary care physicians increased the most, partially because hospitals and health care systems acquired primary care physician organizations. In 2016, 90 percent of Metropolitan Statistical Areas (MSAs) were highly concentrated for hospitals, 65 percent for specialist physicians, 39 percent for primary care physicians, and 57 percent for insurers. Ninety-one percent of the 346 MSAs analyzed may have warranted concern and scrutiny because of their concentration levels in 2016 and changes in their concentrations since 2010. Public policies that enhance competition are needed, such as stricter enforcement of antitrust laws, reducing barriers to entry, and restricting anticompetitive behaviors.