This makes a lot of sense. When there is a large consolidation they are able to "cut costs." Cutting costs is done to earn more profit. When you eliminate competition it is easier to justify cutting costs on healthcare quality, because folks have nowhere else to go. This is a strong indictment of the for-profit system and really speaks well for a British system like the NHS--provided you have a clear understanding of how healthcare providers are competing with one another for patients. You can even design competition incentives to try and further boost healthcare quality.

Other than obstetrics, when do patients have time to hospital shop? I do know plenty of people who will drive up to an hour to deliver a baby at the hospital of their choice, but aren’t most other hospital stays either emergency or dictated by your dr?

Lots of great information, as usual, but that quote about being "highly consolidated" just made my eyes wide. I get it. It's obvious, but up until now I have only ever heard that spoken of monopolies, and it's about time we start looking at highly consolidated markets.

In other words, its not always a case of socialized vs private, its a case of making sure the system is organized/aligned such that incentives more favor the customers/patients (their health outcomes and pocketbooks) rather than the vendors/providers. Something to keep in mind in... well... ANY economic discussion. But particularly, I think that point gets lost in the discussions about healthcare in the US. What's great about this channel's comparative systems videos is it shows different ways its done around the world and the pros/cons of each way of going about it, rather than being dogmatic in one particular direction. Keep up the good work Healthcare Triage!

Everything in this video is correct, but keep in mind competition only improves health outcomes for people WHO HAVE HEALTHCARE COVERAGE ALREADY. Many Americans do not have healthcare coverage and seeing the system under a market paradigm is rightfully terrible. We want competition in service, not competition in right to service

Competition can work but with the way it's currently happening in the US, this type of competition doesn't work. If hospitals and insurance companies can charge pretty much whatever they want, that ends up costing patients way too much, which is a type of market failure.

yea.. running healthcare as a business is a bad idea. But competition is not bad.

This channel was a great help to me as I was applying to medical schools last year and trying to learn about the ACA and has only gotten better, though the premise is the same - share solid evidence on important and relevant health policy topics with the world. Thank you, Dr. Carroll!

Could you please make a video on “Certificate of Needs” laws?

Was market size considered as a confounding variable in the study? I can easily see small and mid-sized metro areas producing a strong incentive towards mergers because you can get closer to “cornering the market” more easily. Large metros, like NYC or LA would have less incentive because they’re too big... but large metros are also more cosmopolitan and have more people eating avocado toast and doing yoga. In other words, more cosmopolitan metros have better health outcomes, but they also tend to be bigger and therefore difficult for concentration in the healthcare market to take hold. Could be an interesting hypothesis if it wasn’t already considered.

Got a topic for you: NIHCM just came out with a study based in Massachusetts about inappropriate imaging for non-traumatic first presentation of body pain. One thing the report didn't mention was the involvement of chiropractors, which seem to be covered under the state's general insurance. Their guidelines for imaging tend to be looser (by, like a lot) than most physicians.

An interesting follow-up would be to discuss the benefits/drawbacks of accountable care organizations (ACOs). The ACA established ACOs as a means of paying for quality outcomes rather than per procedure. This has accelerated the consolidation of health care providers.

Love your channel! I'm currently wrestling with the MTHFR gene mutation and its likelihood of causing ASD. I've looked into complications of having MTHFR and vaccines and see no real threat but I'm having a harder time with MTHFR and ASD. Are there any peer reviewed studies on either of these subjects and if so do you think you could explain them? My background is not in the medical field and I find it hard to research such subjects and I'm not even sure I'm looking int he right places. Thank you for your time!

In my town, almost every medical practice has aligned with the town's one hospital, and this has been disasterous. Many residents who live here refuse to doctor here because of the horribly short-sighted policies of the hospital. I made the mistake of going to the "Eye Associates" office in the hospital complex for a standard eye exam, and, despite my warning about my medical condition, they violated my instructions and not only left me bedridden with chest pains for a MONTH but they left me with blurred vision for three months. They weren't even appologetic afterward! The privately-owned eye doctor on the south side of town (one of the few hold outs against the hospital's monopoly) was able to give me better results without ANY harm to my vision or health, something the hospital could not do (not because they lacked the ability, but because of their "policies", which ignore the well-being of the patient because some beurocrat said so). Competition is *VERY* important to healthcare, even if standard economics are a bit out of place in the medical field, if you ask me. Health care needs to be publicly funded and managed by intelligent and reasonable people to be humaine, but I find the likelyhood of either happening (let alone both) to be rather remote at this point.

What keeps these competitions happening within companies? If markets were efficient shouldn't they show up as controlling the internal workings of the most successful companies?

Who else is spending 99of their day watching KZfaq?!

My mom's hospital that she work for did this it was not good she ended up quitting last month for travel nursing.

competition is needed to lower costs

How fragmented is the US hospital market? Outside of major urban areas, it doesn't feel very fragmented.

Care to take on Certificate of Need laws?

Actually in the NHS, the prevailing wisdom seems to be that the opposite is true. Fragmenting the healthcare service drives up admin and procurement costs with no real benefit to patients.

Does this surprise anyone? Not me. Are there studies that explicitly correlate Rx/medical corporate *lobbying* (which enables Rx price hikes, mergers, etc) to health outcomes? I'd love to see a follow up video on such research, assuming it exists.

Great video but Aaron, real question, when is IU buying Lutheran?

Well, hang on, let’s not confuse correlation with causation. Where you’ve got a single-payer healthcare system with clinics competing for patients, sure, you might find clinics competing out of a hunger for revenues rather than a desire to optimise patient outcomes, but you might also find that the clinics that need investment the most get less. Even if you account for that in your funding system, you’ve still got potential problems with clinics deciding to focus on the most profitable conditions and treatments, leading to more complicated and difficult to treat conditions getting under-provided and a burden on those clinics that do provide them. If the apples are all perfect whilst the oranges are all rotten, looking at the total yield of good fruit overlooks a serious systemic problem. Finally, competition between clinics doesn’t mean an awful lot for patients with geographical limitations. If there’s only one regional clinic, or family or other commitments make long distance travel impractical, then a systemic reliance on competition between clinics to maximise outcomes may break down entirely. When you collapse with pains in your chest, you can’t just wait for a better firm to take over your only local cardiac ward that’s stuck in a cycle of performing badly and getting punished with less funding.

Question not really addressed - this seems to apply to competition between providers but does it apply to insurance? For example, my town might have 20 cardiology providers but if my insurance only covers 2 of them tbe other 18 are moot. Who an insurance company covers becomes more important than how many providers are available.

Why is there no Instagram page? I'm on that platform and would love to see your content there.

I think there’s got to be clarity when we talk about “markets” here. Competition between private providers can be good, but it also directly leads to the exact kind of mergers and acquisitions being described. The weird quote at the end just feels a little out of place, because the NHS or the Cuban medical system wouldn’t suffer from large private providers taking massive market share, but whatever the hell our system is or single payer private provider systems could potentially deal with those issues. This is more “why anti-trust needs to be given more teeth,” not an argument against a public provider system like the NHS.

The Buddy system, more heart doctors more business for The Hospital and the other is true as well, Lucky suckers with BIg Ins.

I know doctors hate managed and coordinated care like the day is long... but managed care can improve quality, reduce cost, and improve patient outcome especially if there is a united care plan for patients... so when they go to the hospital, a clinic, a specialist, the pharmacy, and whatever they can easily access and communicate with such facilities... And when you have a more single-payer like system and a more unified system that also means less paperwork and complicating differences in plans. Sure competition can be good... sure the market can be good... but to pretend that market and competition is the only way to fix those issues just sounds like someone stroking their wallet.

3% ....thats like nothing. You would be hard pressed to prove causation from that.

Sick, man

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The first few seconds of this video - What is this guy?!! He should work in Hollywood or the Media industry, with such overt facial and body language expressions!!!

Competition works best in markets with less regulation. In the US, there is way way too much regulation in health care.

Worrying since Capitalism tends towards Monopoly.