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首页> 外文期刊>Clinical journal of the American Society of Nephrology: CJASN >Consolidation in the Dialysis Industry, Patient Choice, and Local Market Competition
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Consolidation in the Dialysis Industry, Patient Choice, and Local Market Competition

机译：透析行业的整合，患者选择和当地市场竞争

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The Medicare program insures >80% of patients with ESRD in the United States. An emphasis on reducing outpatient dialysis costs has motivated consolidation among dialysis providers, with two for-profit corporations now providing dialysis for >70% of patients. It is unknown whether industry consolidation has affected patients' ability to choose among competing dialysis providers. We identified patients receiving in-center hemodialysis at the start of 2001 and 2011 from the national ESRD registry and ascertained dialysis facility ownership. For each hospital service area, we determined the maximum distance within which 90% of patients traveled to receive dialysis in 2001. We compared the numbers of competing dialysis providers within that same distance between 2001 and 2011. Additionally, we examined the Herfindahl-Hirschman Index, a metric of market concentration ranging from near zero (perfect competition) to one (monopoly) for each hospital service area. Between 2001 and 2011, the number of different uniquely owned competing providers decreased 8%. However, increased facility entry into markets to meet rising demand for care offset the effect of provider consolidation on the number of choices available to patients. The number of dialysis facilities in the United States increased by 54%, and patients experienced an average 10% increase in the number of competing proximate facilities from which they could choose to receive dialysis (P<0.001). Local markets were highly concentrated in both 2001 and 2011 (mean Herfindahl Hirschman Index =0.46; SD =0.2 for both years), but overall market concentration did not materially change. In summary, a decade of consolidation in the United States dialysis industry did not (on average) limit patient choice or result in more concentrated local markets. However, because dialysis markets remained highly concentrated, it will be important to understand whether market competition affects prices paid by private insurers, access to dialysis care, quality of care, and associated health outcomes.
机译：Medicare计划认为80％的ESRD患者在美国。重点是降低门诊透析成本在透析提供者之间具有积极的巩固，其中两个营利性公司现在为> 70％的患者提供透析。它尚不清楚行业合并是否影响了患者在竞争透析提供者中选择的能力。我们发现2001年和2011年从国家ESRD登记处开始接受中心血液透析的患者，并确定了透析设施所有权。对于每个医院服务区，我们确定了90％的患者在2001年在2001年接受透析的最大距离。我们在2001年至2011年间相同距离中的竞争透析提供者的数量。另外，我们审查了Herfindahl-Hirschman指数，市场浓度的公制范围从零（完美竞争）到每个医院服务区的一个（垄断）。在2001年至2011年期间，不同独特的竞争供应商的数量减少了8％。然而，增加了设施进入市场，以满足不断上升的照顾需求抵消提供者整合对患者可用的选择数量的影响。美国透析设施的数量增加了54％，患者的竞争近似设施的数量平均增长了10％，从而可以选择接受透析（P <0.001）。本地市场在2001年和2011年度高度集中（意味着Herfindahl Hirschman指数= 0.46; SD = 0.2两年），但整体市场浓度并没有重大变化。总之，美国透析行业的十年整合没有（平均）限制患者的选择或导致更集中的本地市场。然而，由于透析市场仍然高度集中，所以要了解市场竞争是否影响私人保险公司支付的价格，以获得透析护理，护理质量和相关的健康成果是很重要的。

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