Health organization mergers improve quality? The FTC Chair says to show her the evidence.

In December, Edith Ramirez, Chairwoman of the Federal Trade Commission, wrote a NEJM Perspective on antitrust enforcement in health care. Below are some quotes with my emphasis added to highlight a few important points.

The FTC intervenes when there is strong evidence that a merger between health care providers is likely to result in market power that will lead to an increase in prices — through higher insurance premiums and copayments — without corresponding quality improvements.

This is why merging organizations usually argue they’ll increase quality. Whether they actually do so is an empirical matter. Evidence to date is not encouraging.

For quality-related claims to succeed, however, they must be backed by evidence that quality improvements are both likely and attainable only by means of a merger.


The FTC also showed that there are different ways, short of a merger, for hospitals to achieve the benefits of clinical integration, including through the use of clinical practice protocols to ensure consistent treatment and financial incentives for meeting quality-of-care goals.

In JAMA, Thomas Tsai and Ashish Jha also made this point.


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