Impacts of Health Care Industry Consolidation in PittsburghPennsylvania: A Qualitative Study

摘要

While most studies of health care industry consolidation focus on impacts onprices or quality, these are not its only potential impacts. This exploratoryqualitative study describes industry and community stakeholder perceptions ofthe impacts of cumulative hospital, practice, and insurance mergers,acquisitions, and affiliations in Pittsburgh, Pennsylvania. Since the 1980s,Pittsburgh’s health care landscape has been transformed and is now dominated bycompetition between 2 integrated payer-provider networks, health care systemUPMC (and its insurance arm UPMC Health Plan) and insurer Highmark (and itshealth care system Allegheny Health Network). Semi-structured interviews with 20boundary-spanning stakeholders revealed a mix of perceived impacts ofconsolidation: some positive, some neutral or ambiguous, and some negative.Stakeholders perceived consolidation’s positive impacts on long-term viabilityof health care facilities and their ability to adopt new care models, enhancedcompetition in health insurance, creation of foundations, and pioneering medicalresearch and innovation. Stakeholders also believed that consolidation changedgeographic access to care, physician referral behaviors, how educated patientswere about their health care, the health care advertising environment, andeconomies of surrounding neighborhoods. Interviewees noted that consolidationraised questions about what the responsibilities of non-profit organizations areto their communities. However, stakeholders also reported their perceptions ofnegative outcomes, including ways in which consolidation had potentially reducedpatient access to care, accountability and transparency, systems’ willingness tocollaborate, and physician autonomy. As trends toward consolidation are notslowing, there will be many opportunities to experiment with policy levers tomitigate its potentially negative consequences.