Consolidation in the health care market: good or bad for consumers

The health care system has been transforming itself; the big fish are eating the small fish; the small fish are combining to grow big. Providers, including hospitals, physicians, and health plans, are aggressively buying, selling, merging, entering into joint ventures, and otherwise consolidating into larger affiliations. These new enterprises, in turn, form networks that can deliver all the health services a patient may need in a lifetime--acute, home health, and nursing home care, and more--and then compete for insurance contracts to cover the greatest possible number of people. While this market reorganization seems to have a role in tempering spiraling costs, it raises other issues of choice, quality, and access. This issue of States of Health examines how consumer interests are faring in the changing market place.