A comprehensive study has found that hospital mergers and acquisitions in the U.S. do not consistently lower health care costs or improve the quality of care. The study suggests that more strategic quality improvement efforts are necessary for meaningful enhancements in health care delivery.
Hospital mergers and acquisitions in the United States seldom lead to reduced health care costs or improved quality of care, a newly published study has revealed. The systematic review, appearing in the Journal of the American College of Surgeons (JACS), analyzed hundreds of studies and found that these transactions largely fail to deliver the promised benefits.
Authored by a team of experts, including Bhagwan Satiani, a professor of surgery emeritus at The Ohio State University Wexner Medical Center, the study comes at a time when nearly 70% of U.S. hospitals are affiliated with a health system.
This trend toward health care integration, often termed consolidation, has been advocated as a strategy to control costs and enhance care quality.
“Proponents of health care integration have claimed it controls costs and enhances care quality,” Satiani, the lead author, said in a news release. “But we found that evidence is lacking that integration alone is an effective strategy for improving the value of health care delivery.”
The findings are based on a systematic review of studies published between 2000 and 2024, with 37 studies meeting the criteria for inclusion.
Among these, just 23% demonstrated an improvement in care quality, mostly due to enhanced care management processes. Notably, nearly 93% of the studies indicated that hospital charges increased post-integration. Additionally, 81% of the studies assessing health care spending reported higher costs or no change.
“These findings provide an opportunity to better define value with a focus on benefiting patients while balancing the financial stability of the health care industry,” Satiani added. “Quality improvement in health care cannot be achieved by mergers and acquisitions alone.”
The study also highlighted limitations, such as the lack of standard measures for quality, pricing or spending in the reviewed studies. Also, the reasons behind the lack of change in health care value post-integration were not fully explored.
A Different Perspective on Integration
Satiani emphasized that the team’s systematic review differs from previous research in two significant ways.
First, many studies on health care integration are published in health policy and economics journals, often bypassing medical professionals like surgeons whose services significantly impact health care expenditures.
Surgical services account for about one-third of U.S. health care expenditures and have a direct bearing on overall health care quality.
“Surgical outcomes also have a direct impact on overall health care quality,” he added.
Secondly, this study stands out because it is among the few systematic reviews aimed at reducing bias and comprehensively examining aspects of health care integration.
Implications for Health Care Leaders
Satiani advocates for health care leaders to invest organizational resources in quality improvement efforts and standardize quality metrics. He cited the American College of Surgeons Quality Verification Program as an example of how surgical quality can be improved.