Financial Integration's Impact On Care Delivery And Payment Reforms: A Survey Of Hospitals And Physician Practices

Health Aff (Millwood). 2020 Aug;39(8):1302-1311. doi: 10.1377/hlthaff.2019.01813.


Health systems continue to grow in size. Financial integration-the ownership of hospitals or physician practices-often has anticompetitive effects that contribute to the higher prices for health care seen in the US. To determine whether the potential harms of financial integration are counterbalanced by improvements in quality, we surveyed nationally representative samples of hospitals (n = 739) and physician practices (n = 2,189), stratified according to whether they were independent or were owned by complex systems, simple systems, or medical groups. The surveys included nine scales measuring the level of adoption of diverse, quality-focused care delivery and payment reforms. Scores varied widely across hospitals and practices, but little of this variation was explained by ownership status. Quality scores favored financially integrated systems for four of nine hospital measures and one of nine practice measures, but in no case favored complex systems. Greater financial integration was generally not associated with better quality.

Keywords: Financial Integration; Government programs and policies; Hospital quality; Hospitals; Integrated Delivery Systems; Medical research; Organization of care; Payment; Physician practices; Primary care; Quality of care; Systems of care; consolidation; health policy; quality improvement.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Delivery of Health Care*
  • Hospitals*
  • Humans
  • Ownership
  • Physicians*
  • Quality of Health Care
  • United States