Abstract
Vertical integration of health systems—the common ownership of different aspects of the health care system—continues to occur at increasing rates in the United States. This systematic review synthesizes recent evidence examining the association between two types of vertical integration—hospital-physician (n = 43 studies) and hospital-post-acute care (PAC; n = 10 studies)—and cost, quality, and health services utilization. Hospital-physician integration is associated with higher health care costs, but the effect on quality and health services utilization remains unclear. The effect of hospital-PAC integration on these three outcomes is ambiguous, particularly when focusing on hospital-SNF integration. These findings should raise some concern among policymakers about the trajectory of affordable, high-quality health care in the presence of increasing hospital-physician vertical integration but perhaps not hospital-PAC integration.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 3-42 |
| Number of pages | 40 |
| Journal | Medical Care Research and Review |
| Volume | 82 |
| Issue number | 1 |
| DOIs | |
| State | Published - Feb 2025 |
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Ms. Harris and Ms. Philbin were supported by the Agency for Healthcare Research and Quality under grant award T32 HS000084. This paper\u2019s contents are solely the responsibility of the authors and do not necessarily represent the official views of the AHRQ. All other authors received no financial support for the research, authorship, and/or publication of this article.
Keywords
- cost of care
- health services utilization
- hospital-physician relationships
- post-acute care
- quality of care
- vertical integration
ASJC Scopus subject areas
- Health Policy