Antitrust and Market Competition Playing Favorites — State Protection of Academic Medical Centers from Antitrust Oversight New England Journal of Medicine Jaime S. King, Katherine L. Gudiksen, Anna D. Sinaiko The authors explore a new trend with U.S. academic medical centers (AMCs) merging with nonacademic hospitals and health care systems.  These mergers pose risks of price increases and other competitive harms.  Regulators should review all transactions involving an AMC and ensure that any promised benefits from consolidation do not harm the public.  Notably, at least four states have laws explicitly […]

Healthcare Markets and Acquisitions Health Insurance After Corporatization —What Next? New England Journal of Medicine Perspective Leemore Dafny, Ph.D. The author explores whether the corporatization of the U.S. health insurance industry (i.e., the consolidation of insurers within and across markets) contributes to the industry’s poor performance among the commercially insured population. The answer is maybe. One key driver of such consolidation is the “technology of insurance.” Economies of scale drive insurance consolidation by lowering costs and stabilizing risk for larger insurers, but beyond a certain size, these advantages fade, and […]

Healthcare Costs Growth In National Health Expenditures: It’s Not The Prices, Stupid Health Affairs Michael Chernew The article seeks to identify the causes of rising healthcare costs by assessing trends across sectors, including coding intensity, AI medical services, product costs, and healthcare consolidation and administrative shifts. Chernew reports that coding intensity has increased and explores the possible relationship to AI medical services, though notes it may be too early to identify any trends. Broad healthcare infrastructure changes show conflicting trends in prices, and the author advocates for more focus on […]

Antitrust Enforcement Fixing a Broken System: Policy Responses to Hospital Acquisitions of Physician Practices That Limit Health Care Access for U.S. Consumers Progressive Policy Institute Diana Moss, Alix Ware, Lief Lin By 2023, more than half of all independent physician practices (IPPs) were no longer independent, but owned by hospitals, health systems, or corporate entities, meaning 78% of all U.S. physicians were employed by large provider organizations. Loss of IPPs through vertical consolidation leads to higher prices, reduced access, loss of physician autonomy, and reduced patient choice. This study highlights […]

Healthcare Prices and Payments UnitedHealthcare Pays Optum Providers More Than Non-Optum Providers Health Affairs Daniel R. Arnold, Brent D. Fulton Optum has a history of increasing market power through aggressive acquisitions of healthcare services and has been accused of using that market power to impede provider competition for financial gain.  UnitedHealthcare and Optum are parts of the same company, with UnitedHealthcare serving as the insurance arm, and Optum providing healthcare services.  In 2024, Optum, which includes a variety of smaller entities such as a pharmacy benefit manager (PBM) and software […]

Health Care Consolidation and System Reform Health Care Consolidation: Published Estimates of the Extent and Effects of Physician Consolidation Government Accountability Office In 2023, Congress directed the Government Accountability Office to study the extent of healthcare consolidation, the potential role of private equity, and the effects on healthcare quality, access, spending, and costs. The GAO reviewed peer-reviewed empirical studies and reports from January 2021 through July 2025, and interviewed stakeholders, including physicians, hospitals, insurers, private equity firms, retail companies, and employees. The article cited available data sources, including PECOS, insurer […]

Primary Care Impact of primary care market mergers on quality: Evidence from the English NHS (Journal of Health Economics) Yuan Lyu, Zhaocheng Zhang This article examines the growing trend of market consolidation among primary care providers and assesses the impact of mergers and acquisitions on the English primary care market. The authors first look at the reasons behind primary care mergers.  They identify the three most significant issues as practitioners retiring (causing a small practice to merge with another), offices consolidating functions to practice more efficiently, and failing practices merging with […]

Impact of Federal Hospital Policies Sharp Rise In Urban Hospitals With Rural Status In Medicare (Health Affairs) Yang Wang, Jared Perkins, Christopher Whaley, Ge Bai This article aims to quantify the impacts of Geisinger Community Medical Center v. Secretary, United States Department of Health and Human Services, and Lawrence Memorial Hospital v. Burwell, which began allowing hospitals to qualify for both urban wage indexes for calculating Medicare reimbursements and Medicaid rural health policies designed to support rural healthcare.  The authors assess changes by tracking the proportions of administratively and geographically rural and […]

Healthcare Consolidation Defining Health Care “Corporatization” (The New England Journal of Medicine) Erin C. Fuse Brown In this brief article, Fuse Brown draws on the prescient work of Paul Starr who, in his 1982 book the Social Transformation of American Medicine, foretold the coming of large healthcare conglomerates. Through consolidation, concentration, and increased focus on profits over patients, the author asserts that we have reached the “Gilded Age” of medicine, replete with dissatisfaction for all – producers, providers, and consumers. While Starr’s 40-year-old prediction has proven to be largely accurate, Fuse […]

Healthcare Cost Control State Health Care Cost Commissions: Their Priorities and How States’ Political Leanings, Commercial Hospital Prices, and Medicaid Spending Predict Their Establishment (The Milbank Quarterly) Brent D. Fulton, Daniel R. Arnold, Jordan M. Wolf, Richard M. Scheffler As healthcare costs continue to rise, states play an increasingly important role in addressing affordability and cost containment. In this Milbank Quarterly article, researchers examine the political and economic measures in the 17 states that have created Health Care Cost Commissions (HCCCs).  HCCCs are independent administrative bodies usually housed in the […]