The funny thing about studies is that no matter the topic you can almost always find “evidence” to prove what you have already decided to be true – whether it is based in fact or not.
This is the case with the recent opinion piece in the New York Times written by Austin Frakt entitled “Hospital Mergers Improve Health? Evidence Shows the Opposite.”
The issues begin with his title when he uses the word evidence. Frakt’s attack on the quality of care in consolidated U.S. hospitals is based largely on a mix of studies none of which allow one to make that claim. Most of the studies he mentions examine health care in the United Kingdom or outcomes at physician practices. As the old adage says – this is comparing apples to oranges.
The truth is that the studies he mentions have serious limitations that prevent us from making broad generalizations; some of the studies look at single year time frames, some look at specific conditions. Others only find marginal results in very small sub-populations. Few have a comparison group. Most only look at mortality in a single procedure.
There are studies published by the Robert Wood Johnson Foundation and the Journal of the American Medical Association that point to the positive effect on quality associated with hospital mergers. Positives like improvements in quality and reductions in mortality. Conveniently, these are not mentioned in the article.
Among the benefits of hospital consolidation is a way to reduce care fragmentation and improve outcomes and efficiencies through economies of scale.
Hospitals are facing increasing cost pressures as well as payments from government programs like Medicare and Medicaid that fall far below the cost of care. Consolidation can save hospitals from closure and ensure communities have access to needed care.
Before jumping to conclusions we need to make sure we are comparing apples to apples and using current, complete, and meaningful data. At this point the literature looking into the association of competition and quality is nascent, riddled with limitations, non-generalizable and as a whole inconclusive. The jury is still out – more rigorous and longitudinal research is needed. In the meantime, we need to refrain from misleading conclusions that consolidation does not improve, or even worsens quality.
