class: center, middle, inverse, title-slide # Vertical integration among health care providers in Massachusetts ## Presenter: Vilsa Curto ### Discussant: Ian McCarthy ### ASHEcon Annual Meeting, June 23, 2021 --- <!-- Adjust some CSS code for font size, maintain R code font size --> <style type="text/css"> .remark-slide-content { font-size: 30px; padding: 1em 2em 1em 2em; } .remark-code, .remark-inline-code { font-size: 20px; } </style> <!-- Set R options for how code chunks are displayed and load packages --> # Vertical Integration .center[  ] --- # Why do we care? - Very important area of health care research - Lots of interest in this topic among policy-makers - Large price effects, little (or no) quality improvement --- # Where we've been... - Cuellar, Gertler, Ciliberto, Dranove, Baker, Bundorf, Kessler...ahead of their time in studying price effects of integration - Some limitations in data, but early results showed increase in prices among integrated hospitals/physicians --- # More recently... - Koch, Capps, Carlin, Dowd, Feldman, Dranove, Ody, Walden, Whaley, and this paper!...recent studies with very good data - Vertical integration increases physician prices, increases hospital prices, increases referrals to integrated providers, decreases referrals to non-integrated providers, doesn't do much for quality --- # Where we're headed... **WHY?** - Dranove and Ody show site-based payment differentials are one reason - Maybe the 340B drug discount program? Alpert, Hsi, and Jacobson don't find much here - Attempt to excel under new payment models (ACOs, bundled payments, HRRP, VBP)? - Standard bargaining motives? - Foreclosure of rivals? - Who is acquired/acquiring?