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Policymakers must ‘do no harm’ regarding healthcare — Jack Yoest

With higher costs and today’s increased demand for care, hospitals — especially those serving rural communities — have been forced to make impossible choices.

With higher costs and today’s increased demand for care, hospitals — especially those serving rural communities — have been forced to make impossible choices.

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“First, do no harm” is the oath physicians take when they embark upon their medical careers. It embodies our societal commitment to ethical medical practice and the well-being of patients. It serves as a moral guide for physicians. It reminds them of their profound responsibility to care for and heal the sick with compassion and respect.

Given the state of American healthcare today — and the role that misguided government regulation has played in exacerbating the problem — it may well be one that policymakers should start taking. Maintaining access to affordable and quality healthcare is becoming increasingly difficult for Americans, but how can they be mindful of cost containment and not worsen the problem?

Rightly so, much of the focus in the discussion has been on the financial burden to patients and how this presents difficulty in accessing care. But while this is important, it is only one part of the equation. With higher costs and today’s increased demand for care, hospitals — especially those serving rural communities — have been forced to make the impossible choice between continuing day-to-day quality patient care and investing in up-to-date medical technology.

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For many, the burden has proven to be too much. Since 2005, almost 200 rural facilities nationwide have closed, robbing the surrounding residents of a critical provider of community care and worsening patient outcomes. University of Washington researchers found that populations served by rural hospitals experienced mortality rate increases of 5.9% after closures, partly due to increased travel times for patients and healthcare providers leaving these communities.

Rural hospitals provide more than patient care. When a community loses its hospital, per-capita income falls by 4% and the unemployment rate rises by 1.6%. The community is also less attractive to new employers that may require access to an emergency room to establish a new regional location, negatively affecting local economies further.

To help care providers evenly distribute the increasing burden of patient care costs, the joining of hospitals and health systems into more resilient and patient-oriented providers should be considered and permitted as a market response.

A new study from the Association of American Medical Colleges Research and Action Institute has found that the largest insurers now have far greater market share on average than major hospital systems. This imbalance has undermined the healthcare marketplace, giving insurance companies distorted pricing power and leading to adverse outcomes such as higher patient premiums and lower reimbursements to healthcare providers.

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Unfortunately, this situation has happened partly because regulators, especially at the Federal Trade Commission and Department of Justice, have stacked the deck against hospitals and in favor of insurers. Even though hospital systems have proven that they can reduce the cost of care for patients and providers without sacrificing the benefits of market competition when merging, they have been prevented from engaging in these often necessary activities.

At the same time, regulators have looked the other way as the number of insurers continues to drop precipitously. This has resulted in a situation where the largest health systems have, on average, a combined 43.1% of the market share in each state, while the top three group insurers hold an average of 82.2% of the market share in each state.

In today’s challenging healthcare marketplace, providers can only do so much to continue serving patients if their access to resources and funds is limited by onerous government regulations. Mergers and consolidations are a simple, localized path to keep hospitals open and increase services — without costing the taxpayer.

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Regulators should recognize this and remove unnecessary obstacles to what is often the best — and sometimes the only — option to continue delivering patient care in a cost-effective manner.

Jack Yoest is an associate professor of Practice in Leadership & Management at the Catholic University of America and a former assistant secretary of health and human resources for Virginia. He wrote this for

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