Scientific Program

Conference Series Ltd invites all the participants across the globe to attend 2nd World Congress on Health Economics Policy & Outcomes Research Madrid, Spain.

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Day 1 :

Keynote Forum

Sarah Nivellie

Independent Hospital Pricing Authority | Australia

Keynote: Pricing and funding for safety and quality, to avoid unnecessary and unsafe care

Time : 09:00-09:45

Health Economics 2017 International Conference Keynote Speaker Sarah Nivellie  photo
Biography:

Sarah Neville is the Director, Pricing at the Independent Hospital Pricing Authority (IHPA), and is responsible for delivering the National Efficient Price annually. Sarah’s background is in mathematics and statistics, holding a Ph.D. in statistics from the University of Wollongong. She was invited to present doctoral research at the University of Oxford in 2012. She recently spent six weeks in remote Australia working with Miwatj Health Aboriginal Corporation developing better ways to communicate key health statistics to Indigenous Australians.

Abstract:

In 2016 all Australian governments signed a Heads of Agreement that committed to improve Australians’ health outcomes and decrease avoidable demand for public hospital services through a series of reforms including the development and implementation of funding and pricing approaches for safety and quality.

Subsequently, the Independent Hospital Pricing Authority (IHPA) was directed to advise on options for a comprehensive and risk adjusted model to determine how funding and pricing could be used to improve patient outcomes across three key areas: sentinel events, hospital acquired complications (HACs) and avoidable hospital readmissions.

HACs are complications which occur during a hospital stay and for which clinical risk mitigation strategies may reduce the risk of their occurrence. Identification of most HACs is dependent upon the use of the Condition Onset Flag (COF). The COF is used to indicate whether a diagnosis was present on admission or hospital or occurred during an episode of care. HACs are defined using the criteria of preventability, patient impact (severity), health service impact and clinical priority. The list of HACs is available at https://www.safetyandquality.gov.au.

Currently, IHPA has recommended that all HACs across every hospital face a reduced funding level to reflect the extra cost of a hospital admission with a HAC, including an approach for risk adjustment based on a patient’s complexity. Under this option, the magnitude of the reduction would vary for each HAC.

This talk will focus on the construction and application of the risk adjustment model for the pricing and funding of HACs.

 

 

Health Economics 2017 International Conference Keynote Speaker Barbara Mascialino photo
Biography:

Barbara Mascialino works at Health Economics and Outcome Research Manager at Thermo Fisher Scientific Immuno Diagnostics in Sweden. Barbara is a nuclear physicist with more than 15 years of experience in epidemiology, modelling and data analysis.

Abstract:

The majority of bowel disorders exhibit overlapping symptoms, making diagnosis difficult in primary care (PC). Inflammatory bowel diseases (IBDs) are characterized by chronic inflammation of the gastrointestinal tract; irritable bowel syndrome (IBS) is a functional disorder, with prevalence 10-20%. Endoscopy is the gold standard for detecting and quantifying IBDs, but due to its low prevalence (in Japan: 152x105 persons), it turns negative in most cases, it is expensive, uncomfortable and risky for the patient. F-Calprotectin is a fecal marker of intestine inflammation that can be used as a pre-endoscopic technique to rule out IBDs.

EliA Calprotectin 2 is expected to be launched into the Japanese market in 2017. The present study aims at evaluating the cost-effectiveness of a) EliA Calprotectin 2 test compared to the b) usage of serologic markers CRP and ESR, c) combined usage of these tests, and d) gold standard to distinguish IBD from IBS in Japan.

Methodology: A 18-weeks Markov model was developed for each diagnostic strategy, simulating 1000 patients presenting to PC with unspecific gastrointestinal symptoms. Outcomes include cost savings, cost per corrected IBD diagnosed, and colonoscopies reduction (including their complications). Uncertainty was addressed with sensitivity analysis.

Findings: Table 1 shows that EliA Calprotectin 2 is cost-effective compared to CRP+ESR, and to colonoscopy; it:

1) Results in more corrected IBD diagnoses at a lower price;

2) Reduces the number of unnecessary endoscopies, increasing the number of correctly diagnosed IBD (N=63) and IBS (N=26) patients.

Conclusion: Results show that the usage of EliA Calprotectin 2 as pre-endoscopic diagnostic tool is associated with less colonoscopies, and important cost savings ascribable to reduced resource utilization. F-Calprotectin is a dominant strategy in relation to the comparators; it should be recommended for reimbursement in Japan, and can be considered as good value for money for the health insurance system.

 

EliA Calprotectin 2

CRP+ESR

Colonoscopy

Total costs (YEN)

17 913 568

22 232 221

33 102 599

Average cost/patient (YEN)

17 914

22 232

33 103

N colonoscopies avoided

736

722

0

Colonoscopy- costs avoided (YEN)

22 271 517

21 863 202

0

N correctly diagnosed IBS

683

657

-

N correctly diagnosed IBD

98

35

-

Colonoscopy -complications costs (YEN)

45 955

50 835

141 504

 

  • Health Economics | Macroeconomics | Health Policy | Health Outcome Research | Pharmaceutical Manufacturers | Health Statistics | Behavioural economics
Speaker

Chair

Julia Varga

Hungarian Academy of Sciences| Hungary

Speaker

Co-Chair

Sarah Nivellie

Independent Hospital Pricing Authority | Australia

Biography:

Gary Young is Director of the Northeastern University Center for Health Policy and Healthcare Research, as well as Professor of Strategic Management and Healthcare Systems, Northeastern University.  His research generally covers management, legal, and policy issues affecting the delivery of healthcare services.  Much of his recent research focuses on measuring and evaluating the performance of healthcare providers, particularly for quality of care, and the potential for using financial incentives to improve providers’ performance on quality metrics. Dr. Young has received research funding from both government agencies and private foundations, including the National Science Foundation, Agency for Healthcare Research and Quality, and the Robert Wood Johnson Foundation.  He has published in such journals as the New England Journal of Medicine, Journal of the American Medical Association, Health Affairs, Medical Care, Journal of Health Economics, and Academy of Management Journal.

Abstract:

This study investigated whether vertical integration of hospitals and physicians is associated with better care for patients with cardiac conditions.  A dramatic change in the U.S. hospital industry is the integration of hospital and physicians through hospital acquisition of physician practices. Yet, there is little evidence regarding whether this form of vertical integration leads to better operational performance of hospitals.  The study was conducted as an observational investigation based on a pooled, cross-sectional database.  The study sample comprised over 300 hospitals in the State of California. The time frame for the study was 2010 to 2012.  The key performance measure was hospitals’ degree of compliance with performance criteria set out by the federal government for managing patients with cardiac conditions.   These criteria relate to the types of clinical tests and medications that hospitals should follow for cardiac patients but hospital compliance requires require the cooperation of a hospital’s physicians.   Data for this measure was obtained from a federal web site that presents performance scores for U.S. hospitals.  The key independent variable was the percentage of cardiologists that a hospital employs (versus cardiologists who are affiliated but not employed by the hospital). Data for this measure was obtained from the State of California which requires hospitals to report financial and operation data each year including numbers of employed physicians.  Other characteristics of hospitals (e.g., information technology for cardiac care, volume of cardiac patients) were also evaluated as possible complements or substitutes for physician employment by hospitals.  Additional sources of data included the American Hospital Association and the U.S. Census.  Empirical models were estimated with generalized estimating equations (GEE).  Findings suggest that physician employment is positively associated with better hospital performance for cardiac care.  However, findings also suggest that information technology is a substitute for physician employment.    

Speaker
Biography:

Barbara Mascialino works at Health Economics and Outcome Research Manager at Thermo Fisher Scientific Immuno Diagnostics in Sweden. Barbara is a nuclear physicist with more than 15 years of experience in epidemiology, modelling and data analysis.

Abstract:

Colonoscopy represents the gold standard in case of suspected colonic pathology. However, availability is limited and it brings about avoidable risks for the patients and important costs. F-Calprotectin is a fecal marker of intestine inflammation capable to differentiate between organic and functional intestinal disorder and could therefore potentially, be used as a pre-endoscopic tool to identify patients that   could potentially avoid a colonoscopy. The purpose of this observational prospective study was to quantify in a Secondary Care (SC) setting in Zaragoza (Spain) the burden of colonoscopy in 87 consecutive unselected patients referred to colonoscopy either by Primary Care (PC) or SC doctors (gastroenterologists, or other specialists), and to evaluate the economic impact associated with the pre-endoscopic usage of F-Calprotectin.

Methodology: Diagnosis was established by colonoscopic investigation, and F-Calprotectin levels were evaluated by means of EliA Calprotectin 2 at both the recommended 50 mcg/g, and at the optimal 234.5 mcg/g cut-offs (sensitivity=69%, specificity=87%). Real-life data (including diagnosis, costs, colonoscopy-related complications, and resource utilization) were prospectively collected. Three scenarios (S) were compared: the actual situation (S1) and two simulations (S2=considering patients sent to colonoscopy by PC doctors only, S3=all patients) in which F-Calprotectin is used to select which patients require further investigations.

Findings: In S1, 71 patients (81.6%) were declared healthy after colonoscopy. Using the optimal cut-off, the actual total cost for visits and procedures was 75875€ (average cost/patient 872€); 4.6% of the patients experienced colonoscopy-related complications, which accounted for 7.9% of the total costs. F-Calprotectin reduces the average cost/patient by 250€ (29%) in S2, and by 427€ (49.0%) in S3. The table summarizes the main economic and health effect results at both cut-offs.

Conclusion: Results show that the usage of F-Calprotectin as pre-endoscopic diagnostic tool is associated with less colonoscopies, less complications, and important cost savings ascribable to reduced resource utilization.

 

Cut-off 50mcg/g

Scenario 1

Scenario 2

Scenario 3

Total costs

75 875 €

62 205 €

53 603 €

Average cost/patient

872 €

715 €

616 €

N colonoscopies avoided

0

24

40

Colonoscopy- costs avoided

0 €

7 800 €

13 000 €

N sick patients missed

0

3

3

Total F-Calprotectin costs

0

710 €

1 122 €

Cut-off 234.5mcg/g

(sens=68% spec 87%)

Scenario 1

Scenario 2

Scenario 3

Total costs

75 875 €

54 081 €

38 672 €

Average cost/patient

872 €

622 €

445 €

N colonoscopies avoided

0

34

62

Colonoscopy- costs avoided

0 €

11 050 €

20 150 €

N sick patients missed

0

5

5

Total F-Calprotectin costs

0

710 €

1 122 €

 

 

Speaker
Biography:

Cristina Paez Aviles has a doctoral degree on Nanosciences from the University of Barcelona, Spain. After obtaining her degree as Biotechnology Engineer by the Army Polytechnic School ESPE in Quito-Ecuador (2012), she went to Barcelona to complete a Master degree in Pharmaceutics Industry and Biotechnology from the University Pompeu Fabra (2013). Her research is focused on the processes and ecosystems of innovation, challenges of technology transfer and commercialization for Nanobiotechnologies and Nanomedicine with a multi-KET approach in European and Latin American regional innovation systems. Additional research interests include innovation in medical devices, entrepreneurship and innovation in developing societies.

Abstract:

The current aim to successfully overcome the valley-of-death for emergent technologies is leading to the reassessment of several priority action lines in technological-based public policies. In this regard, Horizon 2020 is fostering the cross-fertilization of Key Enabling Technologies (KETs), considered strategic for the economic growth of Europe. The relevance of this convergent process lies on the improvement or creation of new unique product properties or technology features, which could not have been obtained with a single technology. In the field of healthcare, this scenario could strongly change the healthcare landscape by improving biomedical systems offering personalized, less invasive, smart oriented, and energy harvesting solutions.

The present work analyses several strategies developed in EU-funded nanotechnology projects with healthcare applications in order to identify those characteristics that foster the cross-fertilization of KETs. For that end, the composition and structure of the innovation ecosystem was analysed, as well as the absorptive capacities and dynamic capabilities of five different types of participant organisations. Network and text mining techniques were complemented with interviews of project leaders. Principal findings showed that the degree of clustering of the network as well as the technological diversity of projects are important factors to consider in order to foster the successful cross-fertilization in nano-related projects.

Additionally, it was evidenced that cross-fertilization of KETs is being boosted by organisations that apply of nano-related knowledge in their processes, highlighting the importance of enhancing the capacity to absorb external knowledge, and the ability to integrate and reconfigure this knowledge

and competences in a changing environment. These several contributions have scope to diverse organizations involved in the sector and that aim to foster the interdisciplinary integration of technologies and collaboration in healthcare. This study could also guide policy makers for reshaping and improving nanotechnology related priority lines and health economic policies.

Biography:

Jacqueline Alcalde has her expertise in developing, implement and manages innovative programs supported by the evidence. Her principal’s tools are evaluation and implementation research. She is teaching evaluation, design programs based on evidence and log frame to master and doctoral students. She and her colleagues are doing effort to integrate health personnel (operative and management) and researcher for developing useful research and improve programs implementation.

Abstract:

Strategic priority setting and implementation of strategies to reduce maternal mortality are key to the post MDG 2015 agenda. This article highlights the feasibility and the advantages of using a systematized tacit knowledge approach, using data from maternal health program personnel, to identify local challenges to implementing policies and programs to inform the post MDG era. Communities of practice, conceived as groups of people sharing professional interests, experiences and knowledge, were formed with diverse health personnel implementing maternal health programs in Mexico and Nicaragua. Participants attended several workshops and developed different online activities aiming to strengthen their capacities to acquire, analyze, adapt and apply research results and to systematize their experience and knowledge of the actual implementation of these programs. Concept mapping, a general method designed to organize and depict the ideas of a group on a particular topic, was used to manage, discuss and systematize their tacit knowledge about implementation problems of the programs they work in. Using a special online concept mapping platform, participants prioritized implementation problems by sorting them in conceptual clusters and rating their importance and feasibility of solution. Two hundred and thirty one participants from three communities of practice in each country registered on the online concept mapping platform and 200 people satisfactorily completed the sorting and rating activities. Participants further discussed these results to prioritize the implementation problems of maternal health programs. Our main finding was a great similarity between the Mexican and the Nicaraguan general results highlighting the importance and the feasibility of solution of implementation problems related to the quality of healthcare. The use of rigorously organized tacit knowledge of health personnel proved to be a feasible and useful tool for prioritization to inform implementation priorities in the post MDG agenda.

Speaker
Biography:

Cecile BLEIN has been Graduated from january 2009 as Economist Doctor, from the National University of Lyon. She obtained, as part of her thesis, the public health prize awarded by the French mutual society of the Rhône. Then she started working in the Regional Health Agency in charge of prospective payment for health facilities. Presently she has been working at HEVA company as a health economist based in Lyon, France for 6 years where she has continued his research.

 

 

Abstract:

Different published clinical studies have demonstrated the non-inferiority of trastuzumab subccutaneous (SC) administration versus intravenous (IV) in terms of efficacy, safety and preference in the treatment of patients with HER2 positive [1-2] . Health facilities wanted to have a multicenter evaluation, using data collected in real life, of the economic impact generated beween the two administrations forms.

A sampling plan from 9 health facilities have been conducted to collect economic consumables data for breast cancer patients care pathway’s (all stages) under trastuzumab (IV versus SC). The economic perspective retained was health facilities.

Multicentric evaluation collected 417 questionnaires describing the care pathway of 411 patients, including 245 patients treated within a SC administration form (60%) versus 167 patients within an IV form (40%).

The average cost of consumables for preparation and administration, expressed in euro 2016, is €1.35 VAT (± €0.47) with the SC routes and €12.42 VAT (± €2.20) with the IV routes. Per patient SC administration resulted in significantly cost saving of €11.07 VAT (± €1.36).

The average transport cost for a patient treated within a SC administration form is €17.57 VAT(± €13.97) and €22.22 VAT (± €13.93) within an IV form. This cost is significantly lower by €4.65 VAT(± €13.95) for the SC form. This result is induced by the correlation existing between the patient mode of transport (light health vehicle or personal transport) and the administration form. A more important mode of hospital exit per light health vehicle for the IV form is significantly observed.

 

Speaker
Biography:

Siriporn Pooripussarakul is a PhD student in pharmacy administration, Faculty of Pharmacy, Mahidol University, Thailand. She has got the scholarship from the Thailand Research Fund through the Royal Golden Jubilee Ph.D. Program. She has her expertise in economic analysis of vaccine and health intervention. She also has clinical experience in chronic disease. Her interested area is evaluating economic outcomes of health interventions.

Abstract:

Statement of the Problem: The introduction of new vaccines depends on various criteria, including policies, clinical guidelines and economic considerations. Various stakeholders have differing criteria they view as important in selecting new vaccines. This study aimed to determine vaccine attributes importance to various stakeholders for new vaccine adoption in Thailand, using the best–worst scaling (BWS) method.

Methodology & Theoretical Orientation: Seven vaccine attributes with three levels each, identified from a literature review and semi-structured interviews, were categorized into burden of disease, age group, budget impact, fever from vaccine, severity of disease, vaccine effectiveness and cost of vaccine. Main-effects orthogonal design was used to identify 18 scenarios. A postal survey was conducted among policy makers, healthcare professionals and healthcare administrators during October 2013 and January 2014. Respondents were asked to choose the most important and the least important choices in each scenario. Importance weights were estimated by a conditional logistic regression. Then the relative attribute importance was calculated by the difference between the maximum and minimum coefficient for each attribute divided by the sum of all differences.

Findings: A total of seventy respondents completed the questionnaires. The attribute with highest importance for all groups was severity of disease (35.86%). Fever from vaccine (16.71%), burden of disease (13.48%) and budget impact (12.81%) were not much different importance from each other. For policy makers and healthcare professionals, the attributes with high importance were severity of disease (35.03% and 35.89%), fever from vaccine (22.88% and 16.08%) and burden of disease (14.82% and 15.25%), respectively; whereas the attributes with high importance for healthcare administrators were severity of disease (32.53%), budget impact (15.07%) and fever from vaccine (14.99%), respectively.

Conclusion & Significance: The BWS method makes it possible to take into account multiple criteria from multiple stakeholders for new vaccine adoption. The results revealed the alignment of a desire for high protection against severe disease together with concerns about budget impact and safety of vaccine.

 

Biography:

Delaram Ghodsi is a nutritionist in Department of Community Nutrition at Faculty of Nutrition Sciences and Food Technology, SBMU, Tehran, Iran. Her areas of expertise are designing, planning and evaluation of the community-based nutritional program. She conducted the first comprehensive evaluation, including policy analysis, process and effect evaluation, and cost analysis, of one national nutritional program in Iran. She is working on development and implementation of nutrition strategies to improve children nutritional status, based on the results and challenges found in the evaluation study.

Abstract:

Statement of the Problem: Evidences support that using supplementary foods is good strategy for combating malnutrition in children. In Iran, in the supportive section of a national nutritional program for improvement of nutritional status of children under 6years, monthly food supplement is distributed targeting malnourished/growth retarded children. This study aimed to reports impacts and cost results from this food distribution program in two provinces: Semnan and Qazvin, Iran.

Methodology & Theoretical Orientation: Monthly implementation costs of the program, including food basket, staff, training and education material, travel, and capital, were calculated using accounting records and key informant interviews, in 2014. An activity-based costing (ABC) was applied to calculate monthly program implementation costs per child. To measure the effect of the program, 362 children under coverage of the program and 409 matched children under coverage of Primary Health Care (PHC) system were studies as intervention and control group, respectively. Weight and height of children in both groups were measured at the baseline of the study and 6 month thereafter.

Findings: Although there was improvement in nutritional status of children in both groups at the end of the study, there were not significant differences in anthropometric indices at the end of the study compared to the beginning between two groups (P>0.05). The implementation cost, was   31.5$ per child (the average exchange rate for 2013). About 58.5% of the total cost of the programs was accounted for food baskets. As a proportion of the overall costs, food baskets were the largest component, followed by capital.

Conclusion & Significance: Based on the results, food component is the highest portion of monthly implementation cost. The implementation cost of the program per child is partially low due to implementation of the program via PHC. This program could be more efficient if it was implemented properly by using PHC capacity.

Speaker
Biography:

Sikander Ailawadhi has expertise in the field of plasma cell disorders, specifically Multiple Myeloma and focuses on clinical drug development as well as a special interest in secondary data analysis looking at outcome disparities and healthcare economics. He has accumulated vast experience in the area of disparities in healthcare utilization and outcomes by patient race and ethnicity and how the management, access and effects of therapeutic interventions may be different for various patient subgroups. Several of his research projects focusing on healthcare economics, cost-effectiveness and outcome disparities have been recognized in the form of presentations at national and international meetings as well as peer-reviewed publications.

Abstract:

Background: Cost of cancer care is projected to reach $173 billion by 2020, a 39% increase from 2010. Several factors including psychiatric (psych) comorbidities contribute to this increase. Within the oncology setting, 29-38% of the patients (pts) are reported to have mood disorders and 15% have major depression. Depression alone is associated with increased healthcare utilization in pts with breast, colon, lung and prostate cancers. A 2015 report noted that the presence of at least one psychiatric comorbidity in 300 Leukemia pts was associated with an extra $55,000 per pt in just one year. Similarly, in pts treated with systemic steroids, the incidence of neuropsychiatric disorders can be as high as 75%. However, no such data is available for MM, where more than 90% of pts are treated with steroids, likely increasing risk for mood problems and impacting treatment cost. As such, the aim of our study was to analyze the SEER-Medicare database for healthcare utilization trends and acute cost of care (cost incurred during 6 months after MM diagnosis) in MM pts with or without psych comorbidities.

Methods: Pts diagnosed with MM between 1991-2010 with continuous Medicare coverage (1 year prior to diagnosis-date of death/end of 2012) were included. Pts were categorized as: MM with any psych disorder (MM+P), MM with depression (MM+D) and MM only. Presence of ≥1 inpatient (ipt) or ≥2 outpatient (opt) ICD9 diagnosis codes were used to assign pts to the psych categories. Within MM+P and MM+D groups were subdivided by presence of psych or depression diagnosis prior to MM (MM+P PRE or MM+D PRE). Medicare claims adjusted for inflation (2013) within the first 6 months (mth)/total MM care were summed by drug and total charges. Univariate and multivariate logistic regression models (adjusted for age, year, sex, race, and the Charlson Comorbidity Index; CCI) were performed to determine associations with ipt, opt, and any emergency department (ED) charges after MM diagnosis. Associations between psych conditions prior to MM diagnosis and costs of care after MM diagnosis were assessed using univariate and multivariate proportional odds models.

Results: The study population included 36,007 eligible MM pts with a median follow-up of 1.8 years. 15168 (42%) pts had a psych condition at any time (MM+P), while 9355 (26%) were diagnosed prior to MM diagnosis (MM+P PRE). Depression was present in 8421 pts (23%), 4546 (13%) of those occurring prior to MM diagnosis. In comparison to MM pts, MM+P and MM+D pts tended to be female, White, and had a higher CCI (all p<0.001). When compared to MM pts, those with MM+P PRE and MM+D PRE had significantly higher incidence of MM-related complications (hypercalcemia, renal dysfunction, anemia, fractures and dialysis) at the time of or after MM diagnosis and also required increased overall care (all p<0.001). Both, MM+P and MM+D had higher odds of ipt visits (OR 1.48 and 1.41, resp., p<0.001), ED care (OR 1.48 and 1.37, resp., p<0.001) and opt visits (OR 1.25 and 1.22, resp., p<0.001) as compared to MM only pts. Cost of care analysis showed that MM+P and MM+D pts had a significantly higher cost of opt (OR 1.36 and 1.39, resp., p<0.001), ipt (OR 1.49 and 1.54, resp., p<0.001) and total care (OR 1.52 and 1.55, resp., p<0.001) as compared to MM only pts during first 6 mth after MM diagnosis (Figure 1). Total costs of care for MM+P and MM+D were also higher than MM only but the differences were less significant. Cost of care differences existed within first 6 mth of MM diagnosis by pt race as well with MM+P among Hispanic and Asian pts being more strongly associated with higher costs than Whites and African-Americans (AA) (p<0.001). MM+D had similar trends but not significant after adjustment for multiple comparisons.

Conclusion: Psych comorbidities are associated with significant increase in healthcare utilization and cost of care in MM pts and may contribute to higher MM-related complications. More research is needed to study whether a multidisciplinary approach to identify and manage MM pts with psych conditions may help mitigate these trends.

Speaker
Biography:

Abstract:

Context: Various forms of multi-hospital systems have become increasingly prevalent in the United States. One reason behind the proliferation is efficiency gain from health system affiliation, which may lower the price of care. The other is enhanced market power from affiliation, which may increase the price of care. This study explores the effects of health system affiliation on selected surgery pricing across different health system types.

Methods: Using a large private insurance claim database, the author identified 22,174 colectomy cases, 15,264 coronary artery bypass graft (CABG) cases, and 111,668 percutaneous coronary intervention (PCI) cases from 2002 to 2007. Health systems were categorized into four clusters: centralized physician/insurance health system (CPIHS), moderately centralized health system (MCHS), decentralized health system (DHS), and independent health system (IHS). The association between negotiated hospital price and health system type was examined.  

Results: Health system affiliation is significantly associated with lower price for less centralized health systems. The CABG and PCI prices in IHS were significantly lower than the prices in non-affiliated hospitals, by 15.6 percent and 13 percent respectively. For centralized health systems, affiliation is significantly associated with higher price. The risk-adjusted PCI price in CPIHS was 2.2 percent higher than in non-affiliated hospitals.

Implications: The current antitrust guidelines tend to emphasize the market share of merging parties, and pay less attention on the characteristics of merging parties. The results of this study suggest that antitrust review can be more effective by considering different health system types.