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Evaluating the Impact of a Consolidated Health Care System on Low-Income Patients in Connecticut Rachel Goldstein

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Evaluating the Impact of a Consolidated Health Care System on Low-Income Patients in Connecticut Rachel Goldstein University of Pennsylvania ScholarlyCommons Social Impact Research Experience (SIRE) Wharton Undergraduate Research 2019 Evaluating the Impact of a Consolidated Health Care System on Low-Income Patients in Connecticut Rachel Goldstein Follow this and additional works at: https://repository.upenn.edu/sire Part of the Business Commons, Community Health and Preventive Medicine Commons, Health and Medical Administration Commons, and the Health Services Research Commons Goldstein, Rachel, "Evaluating the Impact of a Consolidated Health Care System on Low-Income Patients in Connecticut" (2019). Social Impact Research Experience (SIRE). 66. https://repository.upenn.edu/sire/66 This paper is posted at ScholarlyCommons. https://repository.upenn.edu/sire/66 For more information, please contact [email protected]. Evaluating the Impact of a Consolidated Health Care System on Low- Income Patients in Connecticut Abstract Hospitals around the country are adopting new practices and joining hospital systems. While some states have had a relatively mild rate of consolidation, others, like Connecticut, have become heavily dependent on a bifurcated hospital system. Previous papers have mainly considered prices of treatments and availability of care to the broad population. This research paper explores the ability of a consolidated health system to treat and meet UNESCO defined standards for social responsibility in the healthcare sector, particularly for low- income patients. Based on the findings in Connecticut’s New London county, this paper finds that it is possible for a place with a heavily consolidated health system to not only meet UNESCO defined standards, but also to provide high levels of medical care and a variety of services to low income patients. Keywords health care, Connecticut, health system, hospital consolidation Disciplines Business | Community Health and Preventive Medicine | Health and Medical Administration | Health Services Research This working paper is available at ScholarlyCommons: https://repository.upenn.edu/sire/66 Evaluating the Impact of a Consolidated Health Care System on Low-Income Patients in Connecticut Abstract: Hospitals around the country are adopting new practices and joining hospital systems. While some states have had a relatively mild rate of consolidation, others, like Connecticut, have become heavily dependent on a bifurcated hospital system. Previous papers have mainly considered prices of treatments and availability of care to the broad population. This research paper explores the ability of a consolidated health system to treat and meet UNESCO defined standards for social responsibility in the healthcare sector, particularly for low-income patients. Based on the findings in Connecticut’s New London county, this paper finds that it is possible for a place with a heavily consolidated health system to not only meet UNESCO defined standards, but also to provide high levels of medical care and a variety of services to low income patients. Keywords: health Care, Connecticut, health system, hospital consolidation Disciplines: Health Care Management, Social Impact, Urban Development Rachel Goldstein Prof. Djordjija Petkoski The Wharton School Prepared for Wharton Social Impact Research Experience (SIRE) Abstract: Hospitals around the country are adopting new practices and joining hospital systems. While some states have had a relatively mild rate of consolidation, others, like Connecticut, have become heavily dependent on a bifurcated hospital system. Previous papers have mainly considered prices of treatments and availability of care to the broad population. This research paper explores the ability of a consolidated health system to treat and meet UNESCO defined standards for social responsibility in the healthcare sector, particularly for low-income patients. Based on the findings in Connecticut’s New London county, this paper finds that it is possible for a place with a heavily consolidated health system to not only meet UNESCO defined standards, but also to provide high levels of medical care and a variety of services to low income patients. I. Introduction The immense consolidation of hospitals and the subsequent potential for collusion amongst healthcare providers has been a point of concern for the Federal Trade Commission (FTC) since 1981. That year, the FTC filed its first legal complaint challenging a hospital merger in Chattanooga, Tennessee. In its complaint, the FTC stated that the Hospital Corporation of America − a large, proprietary hospital chain − had violated the seventh section of the Clayton Act by owning and managing five out of the eleven hospitals in the area (Hospital Corporation of America v. Federal Trade Commission 1986). With that consolidation, the FTC feared that the remaining four hospital firms in the area would have “control over an entire market so that they would have little reason to fear a competitive reaction if they raised prices above the competitive level” (Hospital Corporation of America v. Federal Trade Commission 1986). The FTC won this case and, for the remainder of the 20th century, proceeded to stop further hospital consolidation that could cause increasing prices or the potential for reduced quality of care. Alexis Gilman of the FTC’s Bureau of Competition stated, “We hit a losing streak: from 1994 through 2000, the federal antitrust enforcers lost all six hospital merger cases they litigated.” Following these continued losses, in 2002, the FTC founded its Hospital Merger Retrospective Project, a joint initiative of the FTC Bureau of Competition and its Bureau of Economics (Gilman 2014). Today, the FTC bases its approach to hospital merger enforcement on the insights it gained from this project. Specifically, the FTC now uses (1) court-defined geographic markets to limit the physical span of hospital systems, (2) non-distinctive treatment of non-profit and for-profit hospitals in regards to market acquisition, and (3) analytic tools to assess a merged hospital’s leverage and prices (Gilman 2014). Following the March 23, 2010 passage of the Affordable Care Act (ACA), even with the work accomplished through the Hospital Merger Retrospective Project, there has been an even greater trend of hospital mergers across the United States, as compared to the pre-ACA trends. In 2011, 93 hospital mergers were announced (Kaufman Hall 2017). This was a large spike from the average of 55 hospital mergers per year from 2002 to 2009. Further, in 2017, there were 115 announced deals, which was a 13% increase from the previous year and the highest number of hospital mergers in American history (Kaufman Hall 2018). While 2018 had a dip in the overall volume of announced deals (i.e., 90 transactions) as compared to 2017, a new trend of “mega- mergers” can be seen in the types of transactions that took place (Kaufman Hall 2019). A “mega-merger” is a colloquial term for a merge or agreement between entire health systems. Until 2016, all American hospital mergers had to be approved by antitrust agencies, and the FTC questioned or stopped only a select, few cases (Abelson 2018). In 2016, the consolidation of hospitals became a smaller area of focus for the FTC and the trend of mega-mergers rapidly began to occur throughout the country. In the state of Connecticut, the mega-merger trend rapidly came to dominate the healthcare field. Further, due to the state’s small geographic size, the consolidation of hospitals has created an almost perfectly bifurcated healthcare system, with nearly every hospital in the state being a part of one of the two major systems − Hartford HealthCare (HHC) and Yale New Haven Health. Angela Mattie, Chair of Connecticut’s Quinnipiac University’s Department of Healthcare Management and Organizational Leadership, has said, “The standalone hospital has gone the way of the dinosaur” (Cuda 2018). II. Intentions and Goals It is important to examine how these mergers will affect cost and the productiveness of healthcare, specifically for low-income patients. Connecticut has reached the point of having only two healthcare systems much faster than many other states. Connecticut may be a model for what a heavily consolidated system of healthcare will look like in the U.S., which is what several other states will trend toward in the next decade. The United Nations Educational, Scientific, and Cultural Organization’s (UNESCO’s) International Bioethics Committee on Social Responsibility and Health defines social responsibility in the healthcare sector as “A task to be shared by the private sector and States and governments, which are called to meet specific obligations to the maximum of the available resources in order to implement and progressively achieve the full realization of this right.” This paper aims to contribute to the literature on the impacts of healthcare consolidation for low- income patients from both financial and qualitative standards. It also aims to analyze and determine if the consolidated healthcare system in Connecticut is capable of achieving this UNESCO-defined goal for social responsibility. The information included in this paper is a result of an analyzation of the practices, performances, and economic data of employees from an individual hospital within one of the two large systems in Connecticut. The hospital chosen for this study was the William W. Backus Hospital in Norwich, Connecticut. Ultimately, this paper focuses on researching how the consolidated health system that is currently found in the state of Connecticut has
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