A substantial amount of integration and concentration has already occurred in health care markets, and this trend will likely continue, particularly as health care providers respond to provisions in the Affordable Care Act (ACA) and other factors that encourage integration. Research looking at hospital mergers suggests that this type of horizontal integration may increase prices; evidence of the impact on quality is mixed. Physician markets are characterized by shifts from practice ownership to employment and from primary care providers to specialists. However, there is little research on the impacts of these market trends. Vertical integration, such as between hospitals and physicians in accountable care organizations (ACOs), is on the rise. While some experts believe that service integration has the potential to deliver better care in a more efficient manner, other experts caution that there is little empirical evidence of success for most arrangements in terms of reducing cost or improving quality. A challenge for policymakers is to develop policies that not only promote integration, but also help maintain well-functioning, competitive health care markets. Among the levers available to policymakers are antitrust enforcement; efforts to promote greater transparency in markets; efforts to promote the use of physician assistants and nurse practitioners and alternative delivery models; payment regulation, tax incentives; and use of the insurance rate review process to assure adequate physician networks. Although evidence from past studies can help guide the development of new policies, additional research is needed to assess the impact of new provider arrangements on cost and quality outcomes.
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