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Comment & Response
July 20, 2021

Strategies to Overcome the Market Dominance of Hospitals—Reply

Author Affiliations
  • 1Stanford University School of Medicine, Stanford, California
  • 2Department of Medical Ethics and Health Policy, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
JAMA. 2021;326(3):278-279. doi:10.1001/jama.2021.6895

In Reply We agree that differences in fee-for-service reimbursements have incentivized hospitals to grow lucrative service lines that cross-subsidize less lucrative services, such as general medicine, geriatrics, pediatrics, and behavioral health.1 This trend has become especially apparent during the COVID-19 pandemic, as we have previously discussed.2 We also agree with Dr Kornitzer’s suggestion that value-based reimbursement models, if appropriately risk adjusted, may help encourage hospitals to compete on the basis of cost-effectiveness and quality of care rather than on the volume or relative value units of services provided.