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Hospitals mergers do not improve quality: study
- neonate 7y agohttp://archive.md/5ZM9V http://archive.md/5ZM9V
- bitxbit 7y agoUnintended consequences of PPACA made the system significantly worse. They let multiple industries consolidate using PPACA as an excuse. Yet no one will talk about it for political reasons. This happened across the board not just among hospitals. I am surprised UNH didn’t start buying out biotech companies to make drugs exclusive to their plans.
- amelius 7y agoBut what happens to cost?
- tehlike 7y agoOnly goes up due to even less competition.
- paulddraper 7y agoCost to the insurance/patient skyrockets because the hospital has better leverage. This is the real reason for rising healthcare costs. Pro tip: go to a smaller clinic or hospital and save $$
- nradov 7y agoPayers (insurers) are increasingly acquiring provider organizations as a cost control measure. The industry is gradually converging on the Kaiser Permanente business model.
- paulddraper 7y agoIn Utah, the reverse is happening where Intermountain Healthcare (provider) started Selecthealth (payer).
- 0xcde4c3db 7y agoHas there literally ever been a case where a merger actually improved things for customers to the extent suggested by the merging companies? I certainly can't think of one.
- warent 7y agoYes! X.com and Confinity merged to become PayPal.
- Retric 7y agoI can’t tell if you’re joking or not. Well done.
- maxerickson 7y agoApple and NeXT? In the case of hospitals, a system occasionally takes over a bankrupt hospital. That isn't particularly worse for the people that continue to have proximity to the services available at the hospital.
- droithomme 7y agoApple agreed to acquire NeXT and its technology in order to bring back Jobs, when Apple was on the cusp of bankruptcy, was absolutely certain to die, and had no negotiating power. It wasn't a merger. Also modern Apple devices are based on the NeXT's operating system and have nothing other than cosmetic and emulative compatibility with MacOS. OSX/macOS is NeXTStep on top of Mach. source: bought $100,000 of APPL in 1997.
- bananocurrency 7y ago>It wasn't a merger. it really sounds like a merge based on two companies becoming one. Not having negotiating power or control doesn't make it not a merger.
- wlesieutre 7y agoEven if you credit all of their software to NeXT, Jony Ive was at Apple pre-NeXT-acquisition and it’s hard to imagine their turnaround going as well as it did without his work on the iMac.
- qrbLPHiKpiux 7y agoThe only thing hospital mergers do in my area is to consolidate the billing and turn it into an absolute non forgiving nickel-and-dime machine.
- hermitdev 7y agoId wish for consolidated billing. Every time I end up in the hospital (which is about twice a year), I seem to end up with bills from 5-6 different providers. 1 from the hospital itself, a separate one from ER services, another from the pharmacy, one each from the specialists I see, another for lab work and yet another from radiology/imaging. This bifurcation of billing makes an easy trap into falling into dilliquency because youre inundated with so many bills for the same visit that, even if you can afford to pay, you're like, "didnt I already pay for this?" Seriously, the hospital near me seems to be a racket for Bill collectors. It seems no one is employed by the hospital proper and that theyre effectively all subcontractors that submit their bills directly to the end client, despite never being notified of that. I cannot imagine a process like this where I hire a contractor to build a house at X rate, and they agree, and then all of the subcontractors bill me directly outside of the initial agreement. Maybe not the best analogy... I fucking hate medical billing practices. (I'm in the US)
- jachee 7y agoIn your house building analogy, you've got a leg up on the medicine-industrial complex by being able to get a value for X up-front.
- zoomablemind 7y agoThe X rate is at least the negotiated professional rate, not necessarily the total bill. Too often hospital care involves out-of-network doctors, that will bill directly as they may not have contract with your insurance. Knowing who'll be on duty ahead of time is not always if at all possible.
- someguydave 7y agoThe reason the doctors are contractors who bill separately is so that they can all be “out of network” and get 100x the rate without giving you prior notice.
- tehjoker 7y agoThere is one case where quality might improve and definitely cost: nationalize them all into a single system.
- asn0 7y agoSince the OP is about studying outcomes ... I'm curious -- are there any reputable studies about the likely outcomes of nationalizing healthcare?
- ggm 7y agohttps://assets.publishing.service.gov.uk/media/57a08d91e5274a31e000192c/The-history-and-development-of-the-UK-NHS.pdf https://assets.publishing.service.gov.uk/media/57a08d91e5274...
- gnopgnip 7y agoThere were many studies done in Australia. It happened about 35 years ago
- casmclas 7y agoHospitals are run and funded by each state in Australia. I think a decade ago the federal government started to run a hospital in Tasmania, but they pulled out of it because it was ridiculous. There are also numerous private hospitals. GPs and specialists are largely privately operated. Comparing Medicare to a single nationalised hospital system is not accurate — it's more like a national health insurance system with membership fees paid by the tax system. Obviously having a single purchaser of so many services allows them a large degree of control, but it isn't even a single payer system, since many health services require extra funds (even a routine doctor's visit requires out of pocket costs for many people, like $30 — that isn't cheap) although that's a recent change. There's also private health insurance and extra fees you can pay for nice service (like a room of your own).
- seibelj 7y agoMany on the left despise mergers and consolidation, and anything that has a hint of monopoly power. Except when it comes to government, education, and healthcare! Doesn’t a single centralized monopoly providing everyone’s healthcare seem like a bad idea? Why is it so bad in business and so good for health?
- whb07 7y agoIn before, “This is proof positive free markets don’t work for healthcare”. Excellent material for those interested, an actual cash only, price listed, customer facing hospital. Shiver ye comrades for the devil capitalist is and has been here. https://www.econtalk.org/keith-smith-on-free-market-health-care/ https://www.econtalk.org/keith-smith-on-free-market-health-c...
- someguydave 7y agoThanks for pointing out reality here. As you can see, it doesn’t go over well here on HN.
- Mountain_Skies 7y agoConsolidation of IT systems should make them easier to protect but in practice it seems like the net result is any IT problem ends up harming multiple hospitals instead of just one. When the same chain owns multiple hospitals in a single market, all of them having IT problems at the same time is dangerous as the others can't pick up the slack.
- jcims 7y agoIT consolidation only happens when it is prioritized, and in many cases you end up with some hybrid system of bastardized mapping/integration tiers rather than a pristine single environment. Healthcare IT also has the challenge of ridiculous amounts of highly specialized and largely turnkey systems, interop with other hospital and research organizations and of course the ever-present regulatory requirements that must be maintained throughout. Didn't read the article but the headline is absolutely not a surprise.
- killjoywashere 7y agoAnybody have full text or a link to the original?
- paulddraper 7y agohttp://archive.md/5ZM9V http://archive.md/5ZM9V
- killjoywashere 7y agoThanks, that the study was published in the New England Journal was enough to find the actual study: https://www.nejm.org/doi/full/10.1056/NEJMsa1901383 https://www.nejm.org/doi/full/10.1056/NEJMsa1901383
- jayd16 7y agoI can't read the article. Does it get into whether the hospitals actually merged process in any useful way? I worked at Kaiser when they were attempting to get their hospitals to share medical records (through SOAP). It taught just how home spun every hospitals IT is. Frankly, I'm a little skeptical much progress could have been made as a result of a recent merger.
- neilwilson 7y agoThe reason you want smaller entities in private healthcare is that is reduces the size and impact of bankruptcy risk. Same reason you want smaller banks. If you want competition to work you have to have sufficient excess capacity in the system to allow entities to fail and fail fast. Not so much a case of big enough to cope, but small enough not to matter that much in the grand scheme of things. That ought to be the rule of thumb for any competition authority - if this new entity went pop, would we notice? Capitalism without the threat of bankruptcy is like Catholicism without the threat of hellfire. It no longer works as a concept.
- known 7y agoI think compulsory https://en.wikipedia.org/wiki/Second_opinion https://en.wikipedia.org/wiki/Second_opinion can improve quality
- Ice_cream_suit 7y agoMergers are about improving profits, not improving quality.
- rejschaap 7y agoFor mergers the best case scenario is probably quality remaining at the same level.
- petjuh 7y agoI can't read the article, it seems to be behind a paywall or something.
- BlameKaneda 7y agohttp://archive.md/5ZM9V http://archive.md/5ZM9V
- RaceWon 7y agoQuality? The peeps who are already make big money running hospital corporations are mainly interested in making more money. Where I work patients are actually to as customers in some interoffice emails... Quality :)
- Heyso 7y agoHospitals, healthcare, should not be a business. If money is the end goal, cheap + efficient medicine will be thrown away, it might not even be profitable ! A curse for a businessman.
- lotsofpulp 7y agoThere aren’t sufficient amount of people willing to do the highly undesirable work of caring for sick, contagious, handicapped, possibly dangerous people without money as the end goal.
- hhmc 7y agoYou can highly remunerate health care professionals without the entire health care system being treated as a for-profit business.
- lotsofpulp 7y agoMy point is someone working in healthcare is also working for money as the end goal, and a doctor/pharmacist/nurse getting paid is also a business transaction.
- Frondo 7y agoAnd none of that would change under single payer (or, as someone else suggested, a German-style model). Absolutely no one anywhere is suggesting doctors and nurses should work for free. Single payer advocates are only suggesting that we cut out the byzantine mechanism of the US medical billing regime, and let the American people pay health care professionals directly, with taxes, instead.
- lotsofpulp 7y agoI’m also not suggesting single payer is a problem. I’m simply claiming that healthcare is a business, regardless of who is paying what. People wanting money for labor to provide healthcare is business.
- huijzer 7y agoNor do business mergers in general. The benefit of mergers is that bigger companies have bigger benefits for top executives. For example, higher status, bigger paycheck and better car for the CEO.
- modmans2nd 7y agoI wonder if they separate the for profit and non-profit mergers what they would find. For profit (in my exe) has always been lower quality.
- Ensorceled 7y agoI'm always fascinated when health care discussions start up on HN; watching Americans argue amongst themselves about single-payer or nationalized health care systems as if those systems are dangerous thought experiments are mesmerizing. No matter how many people say "but a well regulated mandatory multi-payer type of system is working in Germany" or "nationalized medicine is working in Canada" it's all just ignored and the argument continues anew.
- fwsgonzo 7y agoI wonder if we really have to wait a full generation with the "new conditions" (such as national healthcare) already in place for the bickering to taper off. That is, the discussion about how much downtrodden-ness is OK as long as shareholders get increasing value. I mean, at one point for the hospitals to continue to operate at ever more profits you basically have to stop curing people and make them come back. You can combat that with more choices, but nobody is breaking up the banks, so why would they break up the big hospitals? https://3.bp.blogspot.com/-XZHRqu2UjeE/U7LUMgY49HI/AAAAAAAAP7E/k_BVMCdkoqs/s1600/big_bank_merger_chart.jpg https://3.bp.blogspot.com/-XZHRqu2UjeE/U7LUMgY49HI/AAAAAAAAP...
- dsfyu404ed 7y ago>No matter how many people say "but a well regulated mandatory multi-payer type of system is working in Germany" or "nationalized medicine is working in Canada" it's all just ignored and the argument continues anew. Practically nobody is saying that a single payer system or tightly regulated multi-payer system hasn't worked anywhere (we all know Canada exists) or can't work in the US. Everyone is arguing about the specific implementation because those are the details that make or break it. Anything would work on paper. Even free market with some good regulations to promote competition would probably work. It's the specific details of actually implementing something that works (and the ability of the people who would be doing the implementing to get those details right and not be corrupted by existing interests) that everyone is arguing over. Everyone with a brain realizes that when it comes to big systems involving lots of moving parts the fine tuning is what makes or breaks them. Look at all the various social services programs that were kneecapped over the years because someone came along and made a few small changes or some key feature was compromised out of existence. Everyone is bickering over every detail because every detail has the ability to cause massive amounts of hardship when applied at a societal level if said detail is done wrong. Simply put, healthcare is a hard issue because the stakes are so high that nobody is apathetic about it making compromise and consensus hard to reach.
- teekert 7y agoI recently realized that hospitals in the US are for profit. So probably, the mergers do increase returns for investors? Which was probably the goal of the merger anyway.
- snarf21 7y agoRight and this is true for all the other mega-mergers. It doesn't improve quality or lower costs or any of the other lies the companies promise the SEC. It does increase shareholder value and cut jobs.
- chapium 7y agoReduce management overhead and align merged facilities with cookie cutter standards. Ironically a lot of merged systems keep their previous IT infrastructure, so it becomes a big interfacing job rather than standardization.