Evidence map›Paper›PMID 38652542›Full record

ArticleHealth services research2025

New evidence on the impacts of cross-market hospital mergers on commercial prices and measures of quality.

Daniel R Arnold, Jaime S King, Brent D Fulton, Alexandra D Montague, Katherine L Gudiksen, Thomas L Greaney, Richard M Scheffler

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Article in Health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

Daniel R ArnoldSchool of Public Health, University of California, Berkeley, Berkeley, California, USA.ORCID 0000-0001-9969-8389
Jaime S KingFaculty of Law, The University of Auckland, Auckland, New Zealand.
Brent D FultonSchool of Public Health, University of California, Berkeley, Berkeley, California, USA.
Alexandra D MontagueUniversity of California College of the Law, San Francisco, San Francisco, California, USA.
Katherine L GudiksenUniversity of California College of the Law, San Francisco, San Francisco, California, USA.
Thomas L GreaneyUniversity of California College of the Law, San Francisco, San Francisco, California, USA.
Richard M SchefflerSchool of Public Health and Goldman School of Public Policy, University of California, Berkeley, Berkeley, California, USA.

Funding

Arnold Ventures 20-04101Commonwealth Fund 20202666
6 · The paper itself

Abstract

objectiveTo examine the impact of "cross-market" hospital mergers on prices and quality and the extent to which serial acquisitions contribute to any measured effects. DATA SOURCES: 2009-2017 commercial claims from the Health Care Cost Institute (HCCI) and quality measures from Hospital Compare. STUDY

designEvent study models in which the treated group consisted of hospitals that acquired hospitals further than 50 miles, and the control group was hospitals that were not part of any merger activity (as a target or acquirer) during the study period. DATA EXTRACTION

methodsWe extracted data for 214 treated hospitals and 955 control hospitals. PRINCIPAL

findingsSix years after acquisition, cross-market hospital mergers had increased acquirer prices by 12.9% (CI: 0.6%-26.6%) relative to control hospitals, but had no discernible impact on mortality and readmission rates for heart failure, heart attacks and pneumonia. For serial acquirers, the price effect increased to 16.3% (CI: 4.8%-29.1%). For all acquisitions, the price effect was 21.8% (CI: 4.6%-41.7%) when the target's market share was greater than the acquirer's market share versus 9.7% (CI: -0.5% to 20.9%) when the opposite was true. The magnitude of the price effect was similar for out-of-state and in-state cross-market mergers.

conclusionsAdditional evidence on the price and quality effects of cross-market mergers is needed at a time when over half of recent hospital mergers have been cross-market. To date, no hospital mergers have been challenged by the Federal Trade Commission on cross-market grounds. Our study is the third to find a positive price effect associated with cross-market mergers and the first to show no quality effect and how serial acquisitions contribute to the price effect. More research is needed to identify the mechanism behind the price effects we observe and analyze price effect heterogeneity.

Indexed as

Economic CompetitionHealth Facility MergerQuality Indicators, Health CareQuality of Health CareHumansUnited Statescross‐markethealth care competitionhospitalspricequalityserial acquisitions

Identifiers

PMID38652542
PMCPMC11782062

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.