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Markets or monopolies?: considerations for addressing health care consolidation in California
Markets or monopolies?: considerations for addressing health care consolidation in California
Over the past three decades, markets for health insurers and providers have gone through waves of consolidation. As of 2018, 95% of metropolitan areas in the United States had highly concentrated hospital markets. Markets for health insurers are also highly concentrated--between 2006 and 2014, the combined market share of the top four insurers climbed from 74% to 83%. The coronavirus pandemic appears to be fueling another round of consolidation--especially acquisition of providers by private equity firms. While past consolidation typically resulted from mergers and acquisitions, consolidation now also occurs through other types of transactions including joint ventures, strategic alliances, affiliations, and other agreements between companies. Because it is clearly increasing throughout market segments and across the state, it is important to understand different forms of health care consolidation, common measurements of market concentration, the evidence on the effects of past consolidation, the current sources and types of regulatory oversight in California, and potential considerations for future policymaking.
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