Richard M. Scheffler (
Daniel R. Arnold is a postdoctoral fellow in health economics in the School of Public Health, University of California Berkeley.
Health Aff (Millwood). 2018 Sep;37(9):1409-1416. doi: 10.1377/hlthaff.2018.0472.
California has heavily concentrated hospital, physician, and health insurance markets, but their current structure and functioning is not well understood. We assessed consolidation trends and performed an analysis of "hot spots"-markets that potentially warrant concern and scrutiny by regulators in terms of both horizontal concentration (such as hospital-hospital mergers) and vertical integration (hospitals' acquisition of physician practices). In 2016, seven counties were high on all six measures used in our hot-spot analysis (four horizontal concentration and two vertical integration measures), and five counties were high on five. The percentage of physicians in practices owned by a hospital increased from about 25 percent in 2010 to more than 40 percent in 2016. The estimated impact of the increase in vertical integration from 2013 to 2016 in highly concentrated hospital markets was found to be associated with a 12 percent increase in Marketplace premiums. For physician outpatient services, the increase in vertical integration was also associated with a 9 percent increase in specialist prices and a 5 percent increase in primary care prices. Legislative proposals, actions by the state's attorney general, and other regulatory changes are suggested.
加利福尼亚州的医院、医生和医疗保险市场高度集中，但目前其结构和运作方式并不为人所理解。我们评估了整合趋势，并对“热点”市场进行了分析——这些市场在横向集中（如医院间的合并）和纵向整合（医院收购医生诊所）方面可能引起监管机构的关注和审查。在 2016 年，有七个县在我们的热点分析中使用的所有六个指标上得分都很高（四个是横向集中指标，两个是纵向整合指标），还有五个县在五个指标上得分很高。在医院拥有的医生诊所中，医生的比例从 2010 年的约 25%增加到 2016 年的 40%以上。从 2013 年到 2016 年，高度集中的医院市场中垂直整合的增加对市场保费的影响估计为增加了 12%。对于医生的门诊服务，垂直整合的增加也与专科医生价格上涨 9%和初级保健价格上涨 5%有关。建议采取立法提案、州检察长的行动和其他监管改革措施。
