Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA, USA.
RAND Corporation, Santa Monica, CA, USA.
Inquiry. 2020 Jan-Dec;57:46958020976246. doi: 10.1177/0046958020976246.
While most studies of health care industry consolidation focus on impacts on prices or quality, these are not its only potential impacts. This exploratory qualitative study describes industry and community stakeholder perceptions of the impacts of cumulative hospital, practice, and insurance mergers, acquisitions, and affiliations in Pittsburgh, Pennsylvania. Since the 1980s, Pittsburgh's health care landscape has been transformed and is now dominated by competition between 2 integrated payer-provider networks, health care system UPMC (and its insurance arm UPMC Health Plan) and insurer Highmark (and its health care system Allegheny Health Network). Semi-structured interviews with 20 boundary-spanning stakeholders revealed a mix of perceived impacts of consolidation: some positive, some neutral or ambiguous, and some negative. Stakeholders perceived consolidation's positive impacts on long-term viability of health care facilities and their ability to adopt new care models, enhanced competition in health insurance, creation of foundations, and pioneering medical research and innovation. Stakeholders also believed that consolidation changed geographic access to care, physician referral behaviors, how educated patients were about their health care, the health care advertising environment, and economies of surrounding neighborhoods. Interviewees noted that consolidation raised questions about what the responsibilities of non-profit organizations are to their communities. However, stakeholders also reported their perceptions of negative outcomes, including ways in which consolidation had potentially reduced patient access to care, accountability and transparency, systems' willingness to collaborate, and physician autonomy. As trends toward consolidation are not slowing, there will be many opportunities to experiment with policy levers to mitigate its potentially negative consequences.
虽然大多数关于医疗保健行业整合的研究都集中在对价格或质量的影响上，但这并不是它的唯一潜在影响。本探索性定性研究描述了宾夕法尼亚州匹兹堡市的行业和社区利益相关者对医院、实践和保险合并、收购和附属机构的累积影响的看法。自 20 世纪 80 年代以来，匹兹堡的医疗保健格局发生了变化，现在由两个集成支付者-提供者网络之间的竞争主导，即 UPMC（及其保险部门 UPMC Health Plan）和保险公司 Highmark（及其医疗保健系统 Allegheny Health Network）。对 20 名跨越边界的利益相关者进行的半结构化访谈揭示了整合的一些混合影响：有些是积极的，有些是中性或模糊的，有些是消极的。利益相关者认为整合对医疗保健设施的长期生存能力及其采用新护理模式的能力、医疗保险竞争的增强、基金会的创建以及开创性的医学研究和创新产生了积极影响。利益相关者还认为，整合改变了获得医疗服务的地理途径、医生的转诊行为、患者对自身医疗保健的了解程度、医疗保健广告环境以及周边社区的经济状况。受访者指出，整合引发了关于非营利组织对其社区的责任的问题。然而，利益相关者也报告了他们对负面结果的看法，包括整合可能降低患者获得医疗服务的机会、问责制和透明度、系统合作的意愿以及医生自主权的方式。随着整合的趋势没有放缓，将有许多机会尝试使用政策手段来减轻其潜在的负面影响。
