Open AccessFinancial Integration’s Impact On Care Delivery And Payment Reforms: A Survey Of Hospitals And Physician Practices
Author(s) -
Elliott S. Fisher,
Stephen M. Shortell,
A. James O’Malley,
Taressa Fraze,
Andrew T. A. Wood,
Marisha E. Palm,
Carrie H. Colla,
Meredith B. Rosenthal,
Hector P. Rodríguez,
Valerie A. Lewis,
Steven Woloshin,
Nilay D. Shah,
Ellen Meara
Publication year - 2020
Publication title -
health affairs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.837
H-Index - 178
eISSN - 2694-233X
pISSN - 0278-2715
DOI - 10.1377/hlthaff.2019.01813
Subject(s) - payment , business , quality (philosophy) , health care , delivery system , health care delivery , finance , healthcare system , family medicine , medicine , economics , economic growth , philosophy , epistemology , pharmacology
Health systems continue to grow in size. Financial integration-the ownership of hospitals or physician practices-often has anticompetitive effects that contribute to the higher prices for health care seen in the US. To determine whether the potential harms of financial integration are counterbalanced by improvements in quality, we surveyed nationally representative samples of hospitals ( n = 739) and physician practices ( n = 2,189), stratified according to whether they were independent or were owned by complex systems, simple systems, or medical groups. The surveys included nine scales measuring the level of adoption of diverse, quality-focused care delivery and payment reforms. Scores varied widely across hospitals and practices, but little of this variation was explained by ownership status. Quality scores favored financially integrated systems for four of nine hospital measures and one of nine practice measures, but in no case favored complex systems. Greater financial integration was generally not associated with better quality.