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Hospital-Medicare Advantage Vertical Consolidation, 1980 to 2024
Geronimo Bejarano1, Grace Mackleby2, Amal Trivedi1,3
1Brown University School of Public Health, Providence, RI, USA.
Medical Care Research and Review : MCRR
|April 15, 2026
Summary
This study introduces a new dataset tracking hospital-Medicare Advantage (MA) contract consolidation from 1980-2024. It reveals trends and variations in this growing health care market consolidation.
Area of Science:
- Health Economics
- Health Policy
- Antitrust Law
Background:
- Health care consolidation is rising, with a focus on hospital-physician integration.
- Limited data exists on insurer and hospital vertical consolidation, hindering research on its impact.
- Understanding hospital-Medicare Advantage (MA) contract consolidation is crucial for policy and antitrust.
Purpose of the Study:
- To create a novel, longitudinal dataset of hospital-MA contract consolidation (1980-2024).
- To analyze trends, geographic variations, and ownership patterns of hospital-MA consolidation.
- To provide a public dataset for future research on health care market structure.
Main Methods:
- Developed a novel dataset of hospital-MA contract consolidation.
- Analyzed annual trends in consolidation from 1980 to 2024.
- Examined state-level geographic variations and insurer ownership of integrated contracts.
Main Results:
- Hospital-MA contract consolidation shows significant annual trends and geographic variation.
- A quarter of integrated MA contracts are owned by insurers with other non-hospital integrated contracts.
- The novel dataset enables detailed analysis of this consolidation type.
Conclusions:
- The created dataset offers a comprehensive view of hospital-MA contract consolidation.
- Findings highlight the prevalence and complexity of vertical consolidation in the MA market.
- Public data access will support research informing health care policy and antitrust enforcement.
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