Newswise — Healthcare integration has long been touted as a panacea for controlling healthcare costs and improving quality of care.
But the integrated health care system appears to be failing on both fronts, according to a new national survey led by researchers at Harvard University and the National Bureau of Economic Research. (NBER).
Instead, the analysis finds significantly higher costs but slightly better care for patients seen in the healthcare system compared to patients in independent clinics and hospitals.
The research results are Posted in JAMA on January 24.
In recent decades, the U.S. healthcare system has grown exponentially in size and market share through mergers and acquisitions of physician clinics and hospitals, and the consolidation of separate healthcare systems.
During this time, proponents of integration argue that doctors and hospitals working together in an integrated and coordinated system not only provide better care for patients, but also more efficiently than independent doctor’s clinics and hospitals, providing and spending less money. It has been claimed to improve the quality of care while reducing Reduced stable operating costs.
“One of the main arguments for hospital mergers and clinic acquisitions was that the health system would provide more valuable care to patients. It provides strong evidence,” said study lead author Nancy Beaulieu, a fellow in the Department of Health Policy at the Bravatnik Institute at Harvard Medical School.
Today, these systems are responsible for the majority of healthcare provided in the United States. Some employ thousands of doctors, while others are much smaller and more community-based. However, questions remain unanswered about how much care is provided by such systems, or how that care compares favorably with care provided outside the system.
Despite the impact on people’s health and economy, little is known about the actual performance of integrated health organizations, the study’s authors note.
Research in this area has been hampered by a lack of detailed data that would allow meaningful investigation of performance, or even measurement of the scale and extent of care delivery within the healthcare system. The current analysis is believed to be the first comprehensive national study comparing outcomes for patients receiving care within and outside the health system, including those with private insurance and traditional Medicare. .
A total of 580 healthcare systems were included in the analysis, representing 40% of physicians and 84% of general acute care beds. Academic and large non-profit systems account for the majority of system physicians (80%) and system hospital beds (64%).
System hospitals are larger than non-system hospitals, with 67% of system hospitals having 100 or more beds and only 23% of non-system hospitals having 100 or more beds. was Similarly, system physician practices were more likely to have 100 or more physicians than non-system physician practices (74% vs. 12%). The integrated system provided primary care to 41% of traditional Medicare beneficiaries. This does not include people enrolled in the Medicare Advantage Program.
Researchers then analyzed the quality and cost of care provided within the system. Their findings show that patients whose primary care physician is part of the health system receive slightly better care and health benefits on average compared to patients whose primary care physician is part of an independent clinic. It suggests that they report slightly better experiences with care delivery systems.
This is true even though many patients in non-system primary care providers also receive some of their care in hospitals or specialist clinics that are part of the health system. However, research has shown that care within the system is much more expensive, contributing to an increase in overall healthcare spending.
The study found that prices for services from doctors and hospitals within the health system were significantly higher than those from independent doctors and hospitals. Physician services provided within the health system are 12% to 26% more expensive than independent practices. Systems-based hospital services cost, on average, 31% more than care provided by independent hospitals.
A combination of small differences in quality and large differences in health care costs suggests that, on average, health care systems are unaware of the potential to provide better care at the same or less cost, researchers say. said.
Research team members compiled databases from a variety of sources to characterize these health care systems and correlate claims data with information about providers within and outside the health care system. The database stored in NEBR will be made available free of charge to other researchers in the near future.
See the NBER Health Systems Project for more information on the health systems and providers databases and surveys conducted as part of the Health Systems Project.
The researchers say the new database provides an important foundation for future research that could help identify areas where integrated health care systems may outperform independent clinics and hospitals. Or it could help guide the efforts of health systems that still hope to achieve the potential benefits of integration while avoiding increased costs. .
“There is no doubt that a large and sophisticated health care system is superior to an independent system,” said study author David Cutler, Otto Eckstein Professor of Applied Economics at Harvard University. increase. “Large systems tend to be less susceptible to economic downturns and can provide specialized care that is difficult for smaller systems to maintain. However, the expected cost-saving benefits of an integrated healthcare system. has not yet come true.”
Authorship, Support and Disclosure
Co-authors on this study include HMS’ Michael Chernew, J. Michael McWilliams, Mary Beth Landrum, and Andrew Hicks. Maurice Dalton, Angela Yutong Gu, Michael Briskin, Rachel Wu, Zakaria El Amrani El Idrissi, and Helene Machado of NBER also contributed to this study.
This work was supported by a grant from the Agency for Healthcare Research and Quality (AHRQ) U19HS024072.
See the article for the full list of disclosures.