在医疗整合时代保障可及性、可负担性和质量：经验教训与未来启示

We are pleased to presentEnsuring Access, Affordability, and Quality in the Ageof Healthcare Consolidation: Lessons Learned and Insights for the Future. Thisreport looks at the increasing marketplace dominance of large health systems andexplores options for safeguarding competition and protecting patient care. The report builds on a convening held in Washington, DC in May 2024that brought together 17 health policy experts to consider the statusofconsolidation among healthcare providers,the challenges it posesto healthcare, and the legal, regulatory, and policy frameworks that caninfluence its impact. We had the privilege of serving as cochairs of that stellar,nonpartisan Working Group. The meeting was organized by the Health,Medicine, and Society program of the Aspen Institute, with the participationof KFF (formerly known as the Kaiser Family Foundation). Together, we identified a package of strategies that could reduce the abilityof providers to dominate the healthcare landscape in ways that pose a broadthreat to patient care. The Working Group’s vigorous discussions wereinformed by two background papers, which are included as part of thisreport: “Policy Options to Address Consolidation in Healthcare ProviderMarkets,”prepared by Benedic Ippolito of the American EnterpriseInstitute, and “Ten Things to Know about Consolidation in Health CareProvider Markets,” prepared by KFF’s Zachary Levinson, Jamie Godwin,Scott Hulver, and Tricia Neuman. FEBRUARY 2025 Our most sincere thanks go to the Working Group members who offeredtheir exceptional expertise and insights and gave so generously of their time,and to Arnold Ventures, whose support made this project possible. AlanWeil, editor-in-chief of Health Affairs, kept us focused with his remarkableabilities as convening facilitator, and HMS communications consultantKaryn Feiden masterfully synthesized the discussions and research into thisreport. We believe the ideas presented here, and especially the proposals for action,can point the way towards a more competitive healthcare system that honorsthe right of the American people to have equitable access to quality servicesat a price they can afford. This report is dedicated to that shared goal. Kathleen FooteCochair Holly VedovaCochair Report........................................................................................................................................... 2 Background Papers Policy Options to Address Consolidation in Healthcare Provider Markets........................... 26Benedic Ippolito, PhD, MS Ten Things to Know About Consolidation in Health Care Provider Markets........................ 45Zachary Levinson, PhD, MA, MPP, Jamie Godwin, PhD, Scott Hulver, PhD, and Tricia Neuman, DSc, MS Appendices Working Group Participants..................................................................................................... 58Special Guests.......................................................................................................................... 66Program Staff and Acknowledgment....................................................................................... 67Program Conveners.................................................................................................................. 69 American healthcare has become increasingly consolidated over thepast few decades. Health systems*are acquiring hospitals, healthsystems and hospitals are both acquiring physician practices, andphysician practices are pairing up. Some of these mergers andacquisitions occur within the same geographic area, but they are also takingplace across different regions of the country. At the same time, private equityfirms and corporations that have not traditionally provided healthcare services,such as Amazon, are entering the marketplace and aggressively purchasingclinical practices.1 The potential for these developments to tamp down competition hasfostered considerable debate. Two key questions frame the discussions:What is the impact of consolidation on cost, quality, equity, and access toservices? And do existing legal frameworks and regulatory structures atthe federal and state levels offer adequate safeguards against monopolisticpractices? A careful analysis is essential to find the answers and informproposals for policy change. To explore the ramifications of consolidation among healthcare providers,the Health, Medicine & Society (HMS) Program of the Aspen Institute,with the participation of KFF (formerly known as the Kaiser FamilyFoundation), convened a Working Group in May 2024. Funding for theconvening—Ensuring Access, Affordability, and Quality in the Age ofHealthcare Consolidation: Lessons Learned and Insights for the Future—was provided by Arnold Ventures. The meeting was cochaired by KathleenFoote, who recently retired as antitrust chief of the California Office of theAttorney General, and Holly Vedova, who recently retired as director ofthe Bureau of Competition a