This concentration is one of the most significant trends in American health care. It can lead to fewer options for patients and higher prices. recent research has found that higher hospital prices are driving much of the recent increases in US health care spending. Hospitals that are acquired by larger systems sometimes cut important services, like maternity careforcing patients to travel hours to receive the medical services they used to get locally.
What I wrote at the end of last year.America’s smaller community hospitals, many of which are operating at a deficit, have often been forced to explore mergers with larger health systems to keep the doors open.
Higher costs are bad news for patients. But it is notoriously difficult to analyze the clinical consequences of these mergers: Does a more concentrated hospital system also lead to worse care? There are many variables at play, and mergers can disrupt the healthcare market (through those higher prices) in ways that make it difficult to isolate how post-merger changes to a hospital’s operations have contributed to an increase in deaths or readmissions.
A new study on hospital mergers in the UK is trying to shed light on that question. It found that after the hospitals merged, patients are more likely to die during or shortly after a hospital stay and are also more likely to be readmitted a second time in the short term, according to new research from academics from Cornell University and the University of London. These increases begin within a few months of the merger and persist for at least two years, the researchers found.
Most UK hospitals are publicly owned, but the national government still made mergers a priority to improve the performance of its health system by merging hospitals that are in financial difficulty with another hospital. In practice, a UK hospital merger often looks a lot like a US hospital merger: separate facilities that once operated under separate management are brought under the control of a board and team of senior leadership.
The size of the impact of the mergers, especially on mortality, is substantial: the probability that a patient would die in hospital or within 30 days of being discharged increased by 0.4 percentage points, an increase of 27 percent. percent from the pre-fusion death rate of 1.4 percent. They are also 11 percent more likely to be readmitted within 30 days of hospital discharge.
In the 139 hospitals involved in 13 different mergers between 2006 and 2015, this increase in mortality and readmissions translated into an additional 60 deaths and 140 readmissions compared to a large control group of UK hospitals that did not experience a merger during that period.
“Mergers and acquisitions raise a number of antitrust concerns, not the least of which is that market consolidation can lead to higher prices or poorer product quality,” wrote the authors, Elena Ashtari Tafti of the University of London and Thomas Hoe from Cornell, to open his conclusions. “Both of these effects are incredibly important in healthcare markets, which have seen significant merger activity over the past two decades, and where price and quality can literally be a matter of life and death.”
In the US, the evidence on how mergers affect quality of care is limited and mixed. But the UK and its NHS are arguably an ideal setting to study these effects, the authors argue, because the payment and payer mix does not change as a result of the merger. That eliminates a variable that may confound similar research in the US. They studied the period from 2006 to 2015 in part because followed NHS reforms that gave patients more choice about where to seek care and put hospitals on a fixed budget for their operations.
Ashtari Tafti and Hoe tout this special feature of the UK healthcare system as a virtue of their research. They also point out that their findings are the logical extension of previous studies that found that quality of care was better in more competitive hospital markets. But they acknowledged that more work is needed to determine if the results would be replicated in a different health system with a different payment structure, such as the US.
I asked Hannah Neprash, a health care economist at the University of Minnesota, who did not contribute to the research, if she thought what the researchers found in the UK would apply in the US. She noted that the study sample was quite small (13 mergers involving 139 acute care hospitals; for context, the UK control group included around 1,100 hospitals and the US has around 5,000 similar facilities). He also noted some of the specific findings (such as a particularly large increase in kidney-related mortality) that require further scrutiny and explanation, and the researchers mentioned how specific changes in one hospital’s operations after the merger affected quality. clinic and should be studied. future query.
“For me, there’s a lingering question about generalizability, but that’s not really due to differences between hospitals in the US and the UK,” he said.
Patients in the US already report a worse experience when treating hospitals that have gone through a merger. This new research suggests that there is also a measurable effect on the more objective quality of care they receive.
The US healthcare system, given its perverse financial incentives, has led more and more hospitals to merge in an attempt to stay open, operate more efficiently and, in theory, better coordinate services for their patients. Federal regulators have tried to stop such mergers at times, but face various obstacles and constraints. Meanwhile, hospitals have argued that consolidation actually benefits patients —with little empirical evidence to contradict them—to justify such mergers to public officials.
But the lingering concern has been that the quality of care could deteriorate if hospitals face less competition. What Ashtari Tafti and Hoe saw in their research indicates that such concerns need to be taken seriously when regulators review future mergers and acquisitions.
