Integrated health systems cost more care

Health care integration has long been considered a panacea for reducing health care costs and increasing the quality of care.

But according to the results of a new nationwide study led by researchers at Harvard, the integrated health system is failing on both fronts. National Bureau of Economic Research ,NBER,,

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Instead, the analysis finds marginally better care at significantly higher costs for patients seen in health systems than in independent practices or hospitals.

the results of the study are Published in JAMA on 24 January,

In recent decades, health systems in the United States have grown rapidly in size and market share through mergers and acquisitions of physician practices and hospitals and incorporation into separate health systems.

During those years, proponents of consolidation argued that physicians and hospitals working together in integrated, coordinated systems would not only provide better care for patients, but would do so more efficiently than independent physician practices and hospitals. Will enhance the quality of care while spending remains stable and even reduces driving costs.

“One of the key arguments for hospital mergers and practice acquisitions was that health systems would provide better-value care for patients. This study provides the most comprehensive evidence to date that this is not happening,” first author he said Nancy BeaulieuA research associate in the Department of Health Care Policy at the Blavatnik Institute at Harvard Medical School.

Today, these systems account for a large portion of the medical care provided in the United States. Some of them employ thousands of physicians, while others are much smaller and rooted in local communities. But questions about how much care is provided by such systems, or how well that care is compared to care provided outside the system, remain unanswered.

Despite their impact on population health and the economy, little is known about the actual performance of integrated health organizations, the study authors said.

Research in this area has been hampered by a lack of detailed data that allow meaningful examination of performance or even measurement of the scale and scope of care delivery within health systems. The current analysis is believed to be the first comprehensive national study to compare outcomes between patients receiving care within and outside health systems, including patients with private insurance as well as traditional Medicare.

A total of 580 health systems were included in the analysis, covering 40 percent of physicians and 84 percent of general acute care hospital beds. Academic and large non-profit systems account for the majority of system physicians (80 percent) and system hospital beds (64 percent).

System hospitals were larger than hospitals that were not part of the system, with 67 percent of system hospitals having more than 100 beds, while only 23 percent of nonsystem hospitals had more than 100 beds. System physician practices were similarly more likely to have more than 100 physicians than nonsystem practices (74 percent versus 12 percent). Integrated systems provided primary care to 41 percent of traditional Medicare beneficiaries; That doesn’t include people enrolled in the Medicare Advantage program.

Next, the researchers analyzed the quality and cost of care provided within the system. Their findings suggest that patients whose primary care physicians are part of health systems receive better care on average and report slightly better experiences with the health care delivery system, compared to patients whose primary care physicians are part of independent practices. are part.

This is the case even though many patients with non-system primary care providers receive some of their care in hospitals or specialist practices that are part of the health system. However, research has shown that care in the system came at a very high cost, contributing to overspending on health care.

The study found that prices for services from physicians and hospitals within health systems were significantly higher than those from independent physicians and hospitals. Physician services provided within health systems cost 12 percent to 26 percent more than those provided in independent practices. System-based hospital services cost an average of 31 percent more than care provided by independent hospitals.

The small differences in quality combined with the large differences in cost of care suggest that health systems have not realized their potential for better care at the same or lower cost, on average, the researchers said.

Members of the research team compiled a database from a variety of sources to help characterize these health systems and to link claims data with information on health care providers in and outside health systems. The database housed at NEBR will be made available free of charge to other researchers in the near future.

More information about the Health Systems and Provider Database and research carried out as part of the Health Systems Project can be found here NBER Health Systems Project,

The researchers said the new database provides an important foundation for future research that could help identify areas where integrated health systems may outperform independent practices and hospitals or guide efforts for health systems. Still hoping to reap the potential benefits of consolidation, while avoiding the increased costs. ,

“There is no doubt that large, sophisticated health systems have advantages over independent systems,” said the study author. david cutlerOtto Eckstein Professor of Applied Economics at Harvard. “Larger systems are less sensitive to economic downturns and can provide specialized care that would be difficult to maintain in smaller systems. But the expected cost-saving benefits of integrated health systems have not yet materialized.”

authorship, endorsement, disclosure

Study co-authors include Michael Chernew, J. Michael McWilliams, Mary Beth Landrum and Andrew Hicks of HMS. Maurice Dalton, Angela Yutong Gu, Michael Briskin, Rachel Wu, Zakaria El Amrani El Idrisi and Helen Machado of NBER also contributed to this research.

This study was supported by grant U19HS024072 from the Agency for Healthcare Research and Quality (AHRQ).

See article for full list of disclosures,

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