Abby Alpert is an assistant professor of health care management at the Wharton School, University of Pennsylvania, in Philadelphia.
Helen Hsi was an analyst at the Health Policy Research Institute at the University of California, Irvine, when the analysis was conducted.
Health Aff (Millwood). 2017 Apr 1;36(4):680-688. doi: 10.1377/hlthaff.2016.0830.
The health care industry has experienced massive consolidation over the past decade. Much of the consolidation has been vertical (with hospitals acquiring physician practices) instead of horizontal (with physician practices or hospitals merging with similar entities). We documented the increase in vertical integration in the market for cancer care in the period 2003-15, finding that the rate of hospital or health system ownership of practices doubled from about 30 percent to about 60 percent. The two most commonly cited explanations for this consolidation are a 2005 Medicare Part B payment reform that dramatically reduced reimbursement for chemotherapy drugs, and the expansion of hospital eligibility for the 340B Drug Discount Program under the Affordable Care Act (ACA). To evaluate the evidence for these explanations, we used difference-in-differences methods to assess whether consolidation increased more in areas with greater exposure to each policy than in areas with less exposure. We found little evidence that either policy contributed to vertical integration. Rather, increased consolidation in the market for cancer care may be part of a broader post-ACA trend toward integrated health care systems.
在过去的十年中，医疗保健行业经历了大规模的整合。其中大部分整合是纵向的（医院收购医生诊所），而不是横向的（医生诊所或医院与类似实体合并）。我们记录了 2003 年至 2015 年期间癌症护理市场中纵向一体化的增加，发现医院或医疗系统对诊所的所有权比例从约 30%增加到约 60%。这一整合最常被引用的两个解释是 2005 年医疗保险 B 部分支付改革，该改革大幅降低了化疗药物的报销额，以及平价医疗法案（ACA）扩大了医院获得 340B 药品折扣计划的资格。为了评估这些解释的证据，我们使用差异中的差异方法来评估在每个政策的暴露程度更高的地区，整合是否比暴露程度更低的地区增加更多。我们几乎没有证据表明任何一项政策促成了纵向一体化。相反，癌症护理市场的整合加剧可能是 ACA 后更广泛的综合医疗保健系统趋势的一部分。
