Understanding the Wide-Reaching Impact of Healthcare Merger and Acquisition Activity

Document Type : Viewpoint


Department of Emergency and Hospital Medicine, Lehigh Valley Health Network, University of South Florida Morsani College of Medicine (USF), Allentown PA, USA



Over the past decade, US healthcare institutions have increasingly relied on diversification strategies to promote market growth and to improve financial solvency. The most prominent strategic method utilized during that period has been adding scale to organizations, thereby providing them with larger patient population to care for. Many organizations have deployed tactics like expanding their healthcare insurance product, collaborating with commercial insurance companies, and increasing service differentiation by improving customer service, brand identity, and reputation. (Read more...)

  1. Gaynor M. “Examining the Impact of Health Care Consolidation” Statement before the Committee on Energy and Commerce, Oversight and Investigations Subcommittee, U.S. House of Representatives. Social Science Research Network; 2018. https://ssrn.com/abstract=3287848.
  2. Jiang HJ, Fingar KR, Liang L, Henke RM, Gibson TP. Quality of care before and after mergers and acquisitions of rural hospitals. JAMA Netw Open. 2021;4(9):e2124662. doi:1001/jamanetworkopen.2021.24662
  3. O'Hanlon CE. Impacts of health care industry consolidation in Pittsburgh, Pennsylvania: a qualitative study. Inquiry. 2020;57:46958020976246. doi:1177/0046958020976246
  4. O'Hanlon CE, Kranz AM, DeYoreo M, Mahmud A, Damberg CL, Timbie J. Access, quality, and financial performance of rural hospitals following health system affiliation. Health Aff (Millwood). 2019;38(12):2095-2104. doi:1377/hlthaff.2019.00918
  5. Gale AH. Bigger but not better: hospital mergers increase costs and do not improve quality. Mo Med. 2015;112(1):4-5.
  6. Xu T, Wu AW, Makary MA. The potential hazards of hospital consolidation: implications for quality, access, and price. JAMA. 2015;314(13):1337-1338. doi:1001/jama.2015.7492
  7. Lim KK. Impact of hospital mergers on staff job satisfaction: a quantitative study. Hum Resour Health. 2014;12:70. doi:1186/1478-4491-12-70
  8. Noles MJ, Reiter KL, Boortz-Marx J, Pink G. Rural hospital mergers and acquisitions: which hospitals are being acquired and how are they performing afterward? J Healthc Manag. 2015;60(6):395-407.
  9. Sun R, Bozkurt S, Winget M, Cullen MR, Seto T, Hernandez-Boussard T. Characterizing patient flow after an academic hospital merger and acquisition. Am J Manag Care. 2021;27(10):e343-e348. doi:37765/ajmc.2021.88764
  10. Williams D Jr, Pink GH, Song PH, Reiter KL, Holmes GM. Capital expenditures increased at rural hospitals that merged between 2012 and 2015. J Healthc Manag. 2020;65(5):346-364. doi:1097/jhm-d-19-00219
  11. Beaulieu ND, Dafny LS, Landon BE, Dalton JB, Kuye I, McWilliams JM. Changes in quality of care after hospital mergers and acquisitions. N Engl J Med. 2020;382(1):51-59. doi:1056/NEJMsa1901383
  12. Wang E, Arnold S, Jones S, et al. Quality and safety outcomes of a hospital merger following a full integration at a safety net hospital. JAMA Netw Open. 2022;5(1):e2142382. doi:1001/jamanetworkopen.2021.42382
  13. Capps C, Dranove D, Ody C. The effect of hospital acquisitions of physician practices on prices and spending. J Health Econ. 2018;59:139-152. doi:1016/j.jhealeco.2018.04.001
  14. Barnett ML, Mehrotra A, Landon BE. COVID-19 and the upcoming financial crisis in health care. NEJM Catal Innov Care Deliv. 2020;1(2). doi:1056/cat.20.0153
  15. Chen J, Miraldo M. The impact of hospital price and quality transparency tools on healthcare spending: a systematic review. Health Econ Rev. 2022;12(1):62. doi:1186/s13561-022-00409-4
  16. Dafny LS, Lee TH. The good merger. N Engl J Med. 2015;372(22):2077-2079. doi:1056/NEJMp1502338
  17. Badlani N. Ambulatory surgery center ownership models. J Spine Surg. 2019;5(Suppl 2):S195-S203. doi:21037/jss.2019.04.20
  18. Federal Trade Commission (FTC). Federal Trade Commission Withdraws Vertical Merger Guidelines and Commentary. FTC; 2021. http://www.ftc.gov/news-events/news/press-releases/2021/09/federal-trade-commission-withdraws-vertical-merger-guidelines-commentary.
  19. US DOJ. U.S. Department of Justice. https://www.justice.gov/. Accessed May 4, 2022.
  20. Honart C. FTC and DOJ Issue Proposed Merger Guidelines Updates. Stevens & Lee. https://www.jdsupra.com/legalnews/ftc-and-doj-issue-proposed-merger-3183725/#:~:text=The%20goal%20of%20the%20update,of%20Sept.%2013%2C%202023. Published July 20, 2023.
  21. Federal Trade Commission (FTC). FTC Rescinds 1995 Policy Statement that Limited the Agency’s Ability to Deter Problematic Mergers. FTC; 2021. http://www.ftc.gov/news-events/news/press-releases/2021/07/ftc-rescinds-1995-policy-statement-limited-agencys-ability-deter-problematic-mergers.
  22. Federal Trade Commission (FTC). FTC, DOJ Temporarily Suspend Discretionary Practice of Early Termination. FTC; 2021. http://www.ftc.gov/news-events/news/press-releases/2021/02/ftc-doj-temporarily-suspend-discretionary-practice-early-termination.
  23. Federal Trade Commission (FTC). The Treatment of Debt as Consideration. FTC; 2021. http://www.ftc.gov/enforcement/premerger-notification-program/hsr-resources/treatment-debt-consideration.
  24. Federal Trade Commission (FTC). Making the Second Request Process Both More Streamlined and More Rigorous During this Unprecedented Merger Wave. FTC; 2021. http://www.ftc.gov/enforcement/competition-matters/2021/09/making-second-request-process-both-more-streamlined-more-rigorous-during-unprecedented-merger-wave.
  25. Federal Trade Commission (FTC). FTC Adjusts its Merger Review Process to Deal with Increase in Merger Filings. FTC; 2021. http://www.ftc.gov/news-events/news/press-releases/2021/08/ftc-adjusts-its-merger-review-process-deal-increase-merger-filings.
  26. Federal Trade Commission (FTC). FTC Approves Final Order Imposing Strict Limits on Future Mergers by Dialysis Service Provider DaVita, Inc. FTC; 2022. http://www.ftc.gov/news-events/news/press-releases/2022/01/ftc-approves-final-order-imposing-strict-limits-future-mergers-dialysis-service-provider-davita-inc
  • Receive Date: 27 March 2023
  • Revise Date: 11 August 2023
  • Accept Date: 07 October 2023
  • First Publish Date: 09 October 2023