Comment by HillaryBriss
8 years ago
In some states, a distinctive aspect of the hospital provisioning landscape is "Certificate of Need" (CON) laws.
Since new hospitals cannot be constructed without proving a "need", the certificate-of-need system grants monopoly privileges to already existing hospitals. [At least one lawmaker has] argued that the true motivation behind certificate-of-need legislation is that "large hospitals are... trying to make money by eliminating competition" under the pretext of using monopoly profits to provide better patient care.
I think many health systems are using the ACA as a pretext for establishing further monopoly power. Basically the line for the public is "we need all providers in one system so we have all the data and so we can refer patients to the right site of care"
In reality they are bringing all providers under their umbrella to control patients i.e. Market share, and to drive patients to the site of care that is most profitable to them under the constraints of minimizing malpractice risk and quality fines. ACOs are in many cases just a way to increase patient volume at a discount to payers and have nothing to do with risk sharing
Hospitals are an incredibly political powerful entity. The AHA (hospital industry lobbying group) spends about as much as Phrma (pharma lobbying group), but hospitals have massive grassroots political support bc they are huge employers whereas the public hates pharma
/endrant