I’ve written before about the unrealized dreams of Obamacare, unrealized because they were poorly designed. One example is the mostly disappointing results of Accountable Care Organizations, which were created in Obamacare. Another is how hospital-physician group mergers drive up the costs in areas where these mega-systems dominate the local market (Harvard Pilgrim in Boston, for example).
Now comes an editorial by Austin Frakt, PhD in the New York Times that summarized several lines of recent evidence that outcomes are worse in these big hospital system hospitals when competition is suppressed. One example was of markets where cardiologist groups are more concentrated resulted in a 5 to 7% increase in heart attacks. ER visits, hospital readmissions, and deaths also went up. In contrast, he actually mentions the British National Health Service as an example where hospitals essentially competed for GP referrals and improved their quality and outcomes.
The damage that has been done with the incentivized formation of large integrated health systems will be very hard to undo. Large powerful organizations don’t give up their power without a large struggle and many hospitals still enjoy general support in their communities. Even though some are “not for profit,” they often don’t act like it. Unfortunately, it looks like many of us will be stuck with unnecessarily inflated prices from these systems for years to come.
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