Hospital Mergers and Monopolies Put Pressure on Patients

by Sokolove Law

In 2016, both individuals and businesses can expect to spend more on health care as insurers and providers negotiate the costs of expanding coverage under the Affordable Care Act. In Massachusetts, The Boston Globe has reported that, over the past decade, rising health care costs have outpaced the incomes of families, with some premiums rising at double-digit rates. With healthcare costs rising faster than inflation, due largely to increases in the price of drugs, medical devices, and hospital care, patients struggle to find options they can afford.

The December arrest of Martin Shkreli, the CEO of Turing Pharmaceuticals who raised the price of a 62-year-old drug by 5000% overnight, provided the public with an easy villain to shame for the rising costs. Putting Shkreli away for fraud is a victory, and hopefully a deterrent for like-minded profiteers, but there are other, less-visible forces at play behind the escalating prices patients are forced to pay.

Mergers, Monopolies, & What It Means for Those in Need

Another trend accompanying the implementation of the Affordable Care Act is the record number of hospital mergers and acquisitions. There are benefits to this consolidation, such as standardizing best practices and widening the scope of clinical trials, but these mergers and acquisitions have also led to regional monopolies. The decrease in competition, many worry, will not be in the best interest of those seeking the care they need.

A recent study by the Health Care Pricing Project (HCPP) investigates the correlation between fewer options and increased price when it comes to healthcare costs. HCPP studied the hospital market structure of different regions in the U.S., and what they discovered is hardly surprising:

“We estimate that monopoly hospitals have 15.3 percent higher prices than markets with four or more hospitals. Similarly, hospitals in duopoly markets have prices that are 6.4 percent higher and hospitals in triopoly markets have prices that are 4.8 percent higher than hospitals located in markets with four or more hospitals. While we cannot make strong causal statements, these estimates do suggest that hospital market structure is strongly related to hospital prices.”

The fewer options a patient has, the higher the price of care is likely to be. For those who are diagnosed with a disease that entails constant trips to the hospital, price increases add another obstacle to an already challenging journey toward recovery.

Expensive Drugs & the Hidden Costs of Treatment

If someone is diagnosed with cancer, even a $200,000 or $500,000 lifetime policy can be wiped out quickly. Along with chronic visits to the hospital, treatment may involve surgery, radiation therapy, and chemotherapy. If one is living with mesothelioma, it becomes even more complicated: typically, it does not grow a single tumor mass and, because of the way it spreads, it’s difficult to get rid of the cancer completely. Even after treatment, there is possibility of recurrence.

It’s impossible to foresee the total cost of battling cancer. For each patient, they will need to fund a unique combination of co-pays, deductibles, medication for treatment, and medication to help manage the pain that comes with certain therapies. Even accounting for those expenses, costs continue to climb for patients with rare diseases. As Cancer Treatment Center of America points out:

“Cancer patients with complex cases often travel outside their local area to hospitals specializing in certain therapies or treatments. Patients may have to pay for airfare, car rental, food, and lodging. These costs increase when a family member or companion accompanies the patient.”

All of these costs must be borne by the patient and their family. Add to that the wages lost from missing work – both for the patient and their companions – and treatment can quickly become prohibitively expensive.

Information and Resources to Battle the Costs of Treatment

Dealing with the financial strain associated with cancer is complicated and emotional, but there is help. There are a number of organizations which can help a patient strategize for and aid with the massive cost of care and treatment. The HealthWell Foundation, the Cancer Financial Assistance Coalition, and the CancerCare® Co-Payment Assistance Foundation may be able to help a patient secure costly treatment.

For patients suffering from rare and complex cases, such as mesothelioma, receiving specialized treatment often requires the additional expenses of traveling and lodging. There are a number of organizations which offer assistance for patients and survivors. The Air Care Alliance, the Air Charity Network, Lifeline Pilots, and the National Patient Travel Center may offer crucial support in getting a patient to the help they need.

As hospitals merge and options for patients dwindle, it is all the more important to become informed about how to lower the barriers between patients and lifesaving treatment.

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