A comprehensive new study that challenges conventional wisdom about health care consolidation finds that large-scale consolidation of U.S. hospitals is failing to deliver on its promise of improving health care and lowering costs.
This systematic review, published in the Journal of the American College of Surgeons, examined 30 years of research on hospital consolidation and found that mergers typically lead to higher prices without meaningful improvements in the quality of care. I discovered that.
“Proponents of health care integration argue that it lowers costs and improves quality of care,” explains lead author Bhagwan Satyani, MD, of The Ohio State University Wexner Medical Center. “However, we find that there is a lack of evidence that integration alone is an effective strategy to improve the value of healthcare delivery.”
The findings come at a critical time, with nearly 70% of U.S. hospitals now affiliated with large health systems. Researchers found a troubling pattern after analyzing 37 eligible studies from 1990 to 2024.
- 93% of studies showed post-merger price increases
- 81% reported increased costs or no change in spending
- 77% saw a decline or no improvement in quality of care.
Of all the studies examined, only 22% showed an overall positive impact of healthcare integration, and 54% showed worse outcomes.
These results have particular implications for surgical services, which account for approximately one-third of U.S. health care spending. Rather than pursuing mergers alone, Satyani suggests that healthcare leaders focus on targeted quality improvement efforts and standardized metrics.
The research team screened about 1,300 studies that investigated both horizontal integration (mergers between hospitals) and vertical integration (hospitals acquiring physician practices). Their systematic approach aimed to minimize bias while assessing impacts on quality, price, and spending.
“These findings provide an opportunity to better define value, focusing on benefiting patients while balancing the financial stability of the healthcare industry,” said Satyani. Masu.
The study authors recommend that healthcare organizations invest more strategically in their quality improvement infrastructure, rather than relying on mergers to drive performance improvements.
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