Over the last two decades there has been immense horizontal and vertical consolidation of health care providers. Hospitals have merged, physician groups have merged, every type of provider has undergone acquisitions and mergers. And health systems which own hospitals have bought physican practices and other providers. Large insurers have also either started or acquired physican practices. The effect of this has been to increase market power which has meant higher prices and lower quality. The Government Accounting Office was asked to review the effect of all this consolidation, with a focus on Medicare and Medicaid impacts and a possible role of private equity investors.
GAO reviewed the research from the last five years and surveyed a variety of particpants in the health care industry. 47% of physicians are currently employed by or affiliated with hospital systems now, up from under 30% in 2012. Health insurers own another significant chunk and private equity firms own practices with around 7% of physicians. While research has variable results, what it clearly does not show is that all this consolidation has either lowered prices or improved quality, which were the justifications put forth by the consolidators. Physician satisfaction has declined with the loss of autonomy. (GAO Report)
The remedy is obvious–reverse the consolidation by legislation or court action. And help support independent physicians by reducing the immense regulatory burdens imposed on them by Medicare and Medicaid and otherwise eliminating administrative chores and paperwork. Our health system and health care will be far better off with a large number of independently practicing physicians who can focus on patient care.
As a result it takes months to get an appointment with a new doctor or even a follow up appointment with an existing relationship. It doesn’t help that over half the doctors are female and don’t work full time.