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March 2, 2017

Making Health Care Markets WorkCompetition Policy for Health Care

Author Affiliations
  • 1Carnegie Mellon University, Pittsburgh, Pennslyvania
  • 2Aledade Inc, Bethesda, Maryland
  • 3The Brookings Institution, Washington, DC
  • 4University of Southern California, Los Angeles
JAMA. Published online March 2, 2017. doi:10.1001/jama.2017.1173

Many studies have examined trends toward increasing consolidation of physician practices and hospitals in the US health care system and the negative effects of decreased competition on the quality of patient care and health care costs.1 Since 2010, there have been 561 hospital mergers,2 and nearly half of hospital markets are highly concentrated.3 Independent physician practice has declined; 33% of 929 419 active physicians in 2013 were employed by hospitals4 and many more are in affiliate relationships. A recent article acknowledged that there is little evidence of the promised benefits of such consolidation to patients or society, and it called on the presidential administration to “ensure that we have a dynamic health care marketplace.”5

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