Is Bigger Better?: A Closer Look at Small Health Systems in the United States.
Med Care
; 60(7): 504-511, 2022 07 01.
Article
in En
| MEDLINE
| ID: mdl-35679174
ABSTRACT
BACKGROUND:
Research on US health systems has focused on large systems with at least 50 physicians. Little is known about small systems.OBJECTIVES:
Compare the characteristics, quality, and costs of care between small and large health systems. RESEARCHDESIGN:
Retrospective, repeated cross-sectional analysis.SUBJECTS:
Between 468 and 479 large health systems, and between 608 and 641 small systems serving fee-for-service Medicare beneficiaries, yearly between 2013 and 2017.MEASURES:
We compared organizational, provider and beneficiary characteristics of large and small systems, and their geographic distribution, using multiple Medicare and Internal Revenue Service administrative data sources. We used mixed-effects regression models to estimate differences between small and large systems in claims-based Healthcare Effectiveness Data and Information Set (HEDIS) quality measures and HealthPartners' Total Cost of Care measure using a 100% sample of Medicare fee-for-service claims. We fit linear spline models to examine the relationship between the number of a system's affiliated physicians and its quality and costs.RESULTS:
The number of both small and large systems increased from 2013 to 2017. Small systems had a larger share of practice sites (43.1% vs. 11.7% for large systems in 2017) and beneficiaries (51.4% vs. 15.5% for large systems in 2017) in rural areas or small towns. Quality performance was lower among small systems than large systems (-0.52 SDs of a composite quality measure) and increased with system size up to â¼75 physicians. There was no difference in total costs of care.CONCLUSIONS:
Small systems are a growing source of care for rural Medicare populations, but their quality performance lags behind large systems. Future studies should examine the mechanisms responsible for quality differences.
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Medicare
/
Fee-for-Service Plans
Type of study:
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
Limits:
Aged
/
Humans
Country/Region as subject:
America do norte
Language:
En
Journal:
Med Care
Year:
2022
Document type:
Article
Affiliation country:
Vatican City