Hospital consolidation followed by inpatient pediatric service closures, study finds

Recent study findings suggest that hospital consolidation is associated with a reduction of inpatient pediatric services during subsequent years—a new data point for policymakers weighing whether and how to rein in health systems’ consolidation of smaller provider facilities.

Published in JAMA Pediatrics, the analysis by University of Pittsburgh School of Medicine researchers reviewed American Hospital Association annual survey reports from thousands of U.S. hospitals between 2011 and 2020.

The researchers found that inpatient pediatric services provision had broadly decreased across the study period, having been offered at 41.5% of 4,876 hospitals in 2011 to 32.6% of 4,551 hospitals in 2020.

Their primary analysis homed in on 1,088 hospitals, of which 235 joined a larger health system during the study period. Among these, the researchers found that joining a health system was significantly associated with a loss of inpatient pediatric services within five years.

Sensitivity analyses confirmed the association remained significant at four years after joining but not at shorter periods, “although all point estimates were similar,” according to the study.

The researchers wrote that their work is a jumping off point for future research exploring a potential link between inpatient service closures and reduced pediatric acute care access as well as whether the type of hospital consolidation, such as a merger or a buyout, impacts closures.

“Policymakers should consider the potential loss of inpatient pediatric services when reviewing proposed hospital mergers and acquisitions,” they wrote in the journal.

Hospital concentration has been an ongoing trend within the U.S. healthcare sector. It also looks to have continued at a “modest but steady” pace through the earlier part of the COVID-19 pandemic, according to a separate research article published last week in Health Affairs Forefront.

In that piece examining Agency for Healthcare Research and Quality records, researchers found that although the total number of health systems remained similar between 2018 and 2021, “considerable churn” via a combination of mergers and physician affiliations had led to a small number of massive health systems and an increase in relatively small systems. It also determined that, overall, health systems controlled a larger share of all healthcare resources in 2021 than they did in 2018.

Hospital consolidation has been on the tip of regulators' and lawmakers’ tongues in recent months. The Federal Trade Commission has taken steps to block a handful of high-profile mergers and has called on states to rethink antitrust exemptions for nonprofits.

Legislators, meanwhile, have recently sought stakeholder and expert input over the impact hospital consolidation is having on care costs, access and quality. Witnesses have argued both sides of the issue in hearings, with some saying that consolidation deals can help certain providers stay afloat while others warn of “significant harm on markets” with no added benefits for patients.