Hospitals keep getting bigger, but how about better for their patients, too? The data suggest that the prices they charge are rising in part due to industry consolidation, but consumers also need to be extra skeptical of national, direct-to-patient appeals about the advantages of various institutions.
Credit is due to the New York Times for scrutinzing the frenzy of hospital mergers and consolidations that now exert huge sway over patients’ choices, care, and costs:
[A]n analysis conducted for [the newspaper] shows [that] …. mergers have essentially banished competition and raised prices for hospital admissions in most cases, according to an examination of 25 metropolitan areas with the highest rate of consolidation from 2010 through 2013, a peak period for mergers. The analysis showed that the price of an average hospital stay soared, with prices in most areas going up between 11 percent and 54 percent in the years afterward.
The newspaper also reported that:
Dignity Health and Catholic Health Initiatives, two large chains, are expected to become one of the nation’s largest groups — with 139 hospitals in 28 states — by the end of the year. And two of Texas’ biggest systems, Baylor Scott & White Health and Memorial Hermann Health System, recently announced plans to combine.
Separately, the Atlantic Magazine earlier had reported that hospital mergers and consolidations have hit rural and ex-urban areas hard: In the name of economic efficiency, the suits running hospitals not only force sick and injured patients into longer, more difficult travel to fewer bigger medical centers. They also then shut smaller, satellite facilities. This deprives struggling towns of central community institutions, as well as jobs, especially higher paying positions that bring in higher skilled and better paid locals.
And, besides battling behemoths, smaller and mid-size hospitals, especially community institutions, now may be facing an advertising and marketing onslaught targeting patients directly, Stat, an online health and medical news online site reported.
Stat says that hospitals spent a little less than half a billion dollars last year on broadcast, print, and digital advertising and marketing. That came on the heels of a decade in which they amped up such spending, and now, as they will jack up their expenditures in direct-to-consumer advertising for high-revenue treatments like transplants. The hospitals, Stat reported, hope for a “halo effect,” first persuading patients that they excel in costly specialty therapies but also that this extends across the board in care. This is not always clearly the case.
In my practice, I see not only the harms that patients suffer while seeking medical services but also their struggles to access and afford safe, efficient, and excellent care. It’s a fundamental of economics, not just health care, that more competition rather than less benefits markets and consumers. Patients can find excellent care at small- and mid-sized community hospitals, and they can be treated shabbily and badly at name institutions. They need choices.
It’s also hard to understate the burdens on the sick and injured in areas of this country that find themselves increasingly under-served by medical institutions. Traveling great distances on poor roads and in bad conditions gets exponentially harder for patients and families in rural and ex-urban areas. They deserve better.
Let’s also ask how giant hospitals could make themselves better for their most important customers — patients — if they spent less on hype and more on care and concern. Americans have seen how poorly we’ve fared by being among the few industrialized nations in the world to permit Big Pharma to engage in direct-to-patient ads, hyping drugs relentlessly and with little clarity and transparency. Cancer centers and other medical specialty facilities have hawked their wares with the dignity and techniques of used car salesmen. Is this a venture that transplant surgeons and orthopedists, to name a few, are eager to join?
State and federal regulators and lawmakers have work to do to ensure our health care access, affordability, honesty, and integrity.