Healthcare consolidation is delivering savings
Regarding "Quality suffers, costs rise as hospital systems consolidate" (April 17, p. 11), the article represents a rehashing of views the authors of the white paper have articulated in the past, most of which are antithetical to delivering high quality coordinated care. The fact is that healthcare is moving to a more coordinated and comprehensive model that is improving the quality and efficiency of care for patients and their communities.
To succeed, this endeavor requires significant realignment of the hospital field and better integration with physicians and other skilled caregivers. For example, a recent report by Charles River Associates that used contemporary data, completed transactions and in-depth interviews with health system executives confirmed that mergers actually decrease costs and the savings were reinvested in better care with improved quality and an expansion of services. Other studies have confirmed these findings. That same CRA study found that revenue declined following a merger—a finding at odds with the authors' claims that realignment is the cause of higher prices.
The authors' seeming preference would be to return to a world of unconnected providers with even greater government oversight that is not in the best interest of improving care for our patients and our communities. Progress is always painful, but for the hospital field progress is yielding tangible benefits for patients—so turning that clock back is not an option anyone should embrace.
Melinda Hatton
Senior VP and general counsel
American Hospital Association
What do we want? Regulation or a free market?
Regarding the article "Quality suffers, costs rise as hospital systems consolidate" (April 17, p. 11), this is all very complex, but in the end, circular logic. We now want regulation off the free market to protect consumers from the consolidation of the provider infrastructure. But the impetus for consolidation was the forces of competition and the free market itself. So what do we really want, a free market, which this study indicates is leading to higher costs and lower quality, or a regulated market, such as a "Medicare for all" single payer?
Ted Almon
Chairman,
Claflin Co.
Warwick, R.I.
Aloha State's experience might offer lessons for Medicaid, too
Regarding the article "In Medicare, states are far from equal" (April 17, p. 12), while Hawaii has had lower costs per beneficiary in Medicare, it also has historically had more generous Medicaid eligibility, including for those disabled adults receiving general assistance making less than 200% of the federal poverty level prior to the ACA. We have also had broader participation historically by private-sector physicians compared to most states, although increased managed-care restrictions have reduced physician participation since 2009.
Perhaps the truth is that broader access to outpatient care correlates with lower ER and hospital utilization, leading to lower total Medicaid spending. Maybe efforts by many states to control Medicaid costs by restricting utilization of care via restricting eligibility and benefits are actually having the effect of driving total spending per beneficiary up, not down. Restricting care does not restrict disease, which often comes back in more expensive forms.
Dr. Stephen Kemble
Assistant clinical professor of medicine
John A. Burns School of Medicine
University of Hawaii at Honolulu
