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Hospital integration not linked with better care, payment reforms, study finds

Large health systems with multiple subsidiaries aren't more likely to adopt care delivery and payment reforms than smaller systems, according to new research published in Health Affairs.

The findings add to evidence that shows the effect hospital consolidation has on quality outcomes "is at best mixed," according to the study authors. 

For their analysis, researchers from several institutions, including Dartmouth in Lebanon, N.H., the University of California Berkeley and Tufts Medical Center in Boston, wanted to see if potentially anti-competitive hospital integration was offset by improved quality. They reviewed a nationally representative sample of 739 hospitals. The hospitals were stratified by whether they were independent, simple or complex systems. Simple systems were defined as those that owned at least one hospital and practice that weren't owned by a larger health system, while complex systems had multiple subsidiaries.

Researchers then reviewed how the hospitals performed on nine scales measuring adoption of quality and payment reforms. The study found there is little relationship between hospital integration and higher levels of care delivery and payment reforms. While independent hospitals (those with a mean 67 beds) had lower scores for four of nine measures on care and payment, no difference was found between hospitals in simple systems (mean 180 beds) and complex systems (mean 242 beds). 

"Our findings have important implications for current debates about whether the potential benefits of financial integration are sufficient to outweigh the potential harm of reduced competition," the researchers concluded. "The finding of dramatic variations in quality scores across hospitals and practices in each ownership category also argues that financial integration might not be needed to improve care delivery."

Access the full report here

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