IT’S BEEN A common claim that integrating health care services into a consolidated system would yield better outcomes for patients and be able deliver that care more efficiently at lower cost.
But a new study says it just isn’t so.
In one of the first large-scale analyses of both Medicare and commercially-insured patients in US health care systems, Harvard researchers say the promise of health care systems has not been realized. The study, published in JAMA, found that the quality of care was “marginally better” for patients treated in health care systems while the costs of such services were substantially higher.
“Overall, systems really haven’t lived up to the promise of better quality and lower cost,” said David Cutler, a professor of economics at Harvard and senior author of the report.
The study looked at 580 health care systems across the country. To meet that definition, a system had to include at least one acute care hospital, 50 physicians, and at least 10 primary care doctors working in the same region. The study compared outcomes and costs at health care systems with care delivered by hospitals and doctors not part of such systems.
Overall, 40 percent of US physicians work in health care systems and 84 percent of all general acute care hospital beds are in systems. The study found modest differences in measures of health care quality like routine administration of flu shots and pneumonia vaccines, and following established guidelines for cardiovascular and diabetes care. But the better performance of health care systems was “small in magnitude.” There were, however, big cost differences, with prices 12 to 26 percent higher for physician services in health care systems and 31 percent higher for hospital services in such systems compared with non-system care.
When the researchers adjusted the results to account for physician practice size, the price differences were smaller, but remained high for small and medium-sized health systems.
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Executive Editor, CommonWealth
About Michael Jonas
Michael Jonas has worked in journalism in Massachusetts since the early 1980s. Before joining the CommonWealth staff in early 2001, he was a contributing writer for the magazine for two years. His cover story in CommonWealth's Fall 1999 issue on Boston youth outreach workers was selected for a PASS (Prevention for a Safer Society) Award from the National Council on Crime and Delinquency.
Michael got his start in journalism at the Dorchester Community News, a community newspaper serving Boston's largest neighborhood, where he covered a range of urban issues. Since the late 1980s, he has been a regular contributor to the Boston Globe. For 15 years he wrote a weekly column on local politics for the Boston Sunday Globe's City Weekly section.
Michael has also worked in broadcast journalism. In 1989, he was a co-producer for "The AIDS Quarterly," a national PBS series produced by WGBH-TV in Boston, and in the early 1990s, he worked as a producer for "Our Times," a weekly magazine program on WHDH-TV (Ch. 7) in Boston.
Michael lives in Dorchester with his wife and their two daughters.
About Michael Jonas
Michael Jonas has worked in journalism in Massachusetts since the early 1980s. Before joining the CommonWealth staff in early 2001, he was a contributing writer for the magazine for two years. His cover story in CommonWealth's Fall 1999 issue on Boston youth outreach workers was selected for a PASS (Prevention for a Safer Society) Award from the National Council on Crime and Delinquency.
Michael got his start in journalism at the Dorchester Community News, a community newspaper serving Boston's largest neighborhood, where he covered a range of urban issues. Since the late 1980s, he has been a regular contributor to the Boston Globe. For 15 years he wrote a weekly column on local politics for the Boston Sunday Globe's City Weekly section.
Michael has also worked in broadcast journalism. In 1989, he was a co-producer for "The AIDS Quarterly," a national PBS series produced by WGBH-TV in Boston, and in the early 1990s, he worked as a producer for "Our Times," a weekly magazine program on WHDH-TV (Ch. 7) in Boston.
Michael lives in Dorchester with his wife and their two daughters.
Cutler, who specializes in health care and sits on the state Health Policy Commission, said the findings represent another cautionary tale to Massachusetts officials dealing with the merger and consolidation efforts that have characterized the state’s health care landscape.
“As a state, we should continue to be skeptical of claims that consolidation is obviously going to be good,” said Cutler, who chairs the commission’s market and oversight transparency committee. He said the approach to health care players pursuing such mergers should be, “You’ve got to show us the evidence.”
