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The Association Between Hospital Concentration And Insurance Premiums In ACA Marketplaces.

Andrew S Boozary1, Yevgeniy Feyman2, Uwe E Reinhardt3

  • 1Andrew S. Boozary is a visiting scientist at the Harvard T. H. Chan School of Public Health, in Cambridge, Massachusetts, and an assistant professor of policy innovation at the University of Toronto, in Ontario.

Health Affairs (Project Hope)
|April 2, 2019
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Summary

High hospital market concentration increases Affordable Care Act (ACA) Marketplace health insurance premiums by 5%. More insurers lower costs, but not enough to counteract hospital concentration effects. Antitrust efforts may be needed.

Keywords:
Health Economicsconcentrationconsolidationhospitals

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Area of Science:

  • Health Economics
  • Market Analysis
  • Public Policy

Background:

  • Affordable Care Act (ACA) Marketplaces require financial accessibility for viability.
  • The impact of insurer numbers on Marketplace premiums is well-studied, unlike hospital market concentration's role.
  • Understanding factors influencing premium costs is crucial for policy development.

Purpose of the Study:

  • To examine the relationship between hospital market concentration and ACA Marketplace premiums (2014-2017).
  • To assess if the number of insurers modifies the impact of hospital concentration on premiums.
  • To investigate associations between community characteristics and hospital concentration levels.

Main Methods:

  • Analysis of hospital market concentration and Marketplace insurance premiums from 2014-2017.
  • Statistical modeling to evaluate the interaction between insurer numbers and hospital concentration.
  • Examination of community-level socioeconomic factors (median income, unemployment, SNAP usage, education) in relation to hospital concentration.

Main Results:

  • Areas with the highest hospital market concentration experienced premiums 5% higher on average than least concentrated areas.
  • Increased number of insurers correlated with lower premiums, but did not fully offset higher costs from hospital concentration.
  • Higher hospital market concentration was more common in communities with lower median incomes, though not consistently across all socioeconomic indicators.

Conclusions:

  • Hospital market concentration significantly increases ACA Marketplace premiums.
  • Strategies to reduce hospital concentration, potentially through antitrust policy, are important for maintaining Marketplace affordability.
  • Socioeconomic factors, particularly median income, are associated with hospital market concentration, highlighting potential disparities in healthcare access and cost.