In 2009, or the year before the Affordable Care Act passed, the Herfindahl-Hirschman Index (used by the FTC and the DoJ) defined hospital ownership as "highly concentrated" in over 80% of the 380 MSAs (Metropolitan Statistical Areas). Since passage of the ACA, a law that among other things strongly encourages care continuity and coordination between/among providers, hospital mergers and acquisitions continued unabated with over 100 in the past year alone (and over 500 between 2007 and 2012). This matters because studies commissioned by the Robert Wood Johnson Foundation and others show hospital market consolidation generally results in higher prices.
During this 27-minute podcast, Dr. Ginsburg discusses the current state of hospital market concentration and what effect this has on hospital pricing and quality. He describes the impetus for the ACA encouraging care integration, what effect this has on hospital as well as physician group practice consolidation (both horizontally and vertically), what upsides there are to a less silo-ed industry, effects of similar consolidation within the payer/insurance industry and what are or should be appropriate federal efforts to best regulate mergers and acquisitions within the healthcare industry.
Dr. Paul Ginsburg is President (and Founder) of the Center for Studying Health System Change (HSC). The HSC conducts research to inform policymakers and other audiences about changes in
organization, financing and the delivery of health care. Prior to HSC Dr. Ginsburg served as the founding Executive Director of the Physician Payment Review Commission (now the Medicare Payment Advisory Commission). Dr. Ginsburg was a Senior Economist at RAND and served as Deputy Assistant Director at the Congressional Budget Office (CBO). Before that he served on the faculties of Duke and Michigan State universities. He has been named to Modern Healthcare’s “100 Most Influential Persons in Health Care” eight times. He is founding member of the National Academy of Social Insurance, a Public Trustee of the American Academy of Ophthalmology and serves on Health Affairs’ editorial board. He earned his doctorate in economics from Harvard University.
The ACA and Hospital Consolidation: A Conversation with Dr. Paul Ginsburg (June 12, 2013)