Consolidation in health care
How has the world of hospitals changed lately?
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90% of metropolitan areas had highly concentrated hospital markets
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65% had highly concentrated specialist physician markets
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39% had highly concentrated primary care physician markets
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57% had highly concentrated insurance markets
How has physician employment changed lately?
How concentrated is the retail pharmacy industry?
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CVS Corp.: 9,105 stores
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Walgreens: 7,713 stores
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Rite Aid Corp.: 4,515 stores
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Walmart: 4,403 stores
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Express Scripts 29%
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CVS Health 24%
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Optum Rx 13%
How big are the major private insurers?
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Blue Cross/Blue Shield: 37% -
Anthem: 15% -
UnitedHealthcare Group: 13% -
Aetna: 11% -
Cigna: 6%
What difference do all these mergers, acquisitions, consolidations and monopolies make on prices in health care?
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In counties with lower levels of concentrations, prices for hospital admissions, oncology, and radiology services ranged from 4% to 19% lower than in more concentrated areas.
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Added facility fees for procedures are often tacked on to outpatient bills when done in a “hospital facility,” which is often a result of hospital systems buying up smaller practices.
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Drug prices also benefit from monopoly power created through patents. The prices of newly-patented, minimally altered (but not necessarily more efficacious) drugs and generics continue to increase – about 20% of generics saw their price increase by 100% between 2013 and 2017.