This February, between the season’s remaining frost and the primary indicators of spring, we explored new analysis on healthcare affordability. This month we learn in regards to the pricing impacts of vertical consolidation, the first drivers behind the latest surge in nationwide well being spending, and the persistent risk of medical debt for sufferers following acute accidents.
Strategic Choice And Pricing Energy: Optum’s Acquisitions Of Ambulatory Surgical procedure Facilities And Doctor Practices
Derek T. Lake et al.. Well being Affairs. February 2026. Accessible right here.
Researchers from Cornell and Brown Universities analyzed Medicare and industrial claims knowledge from 2013–2021 to judge how Optum’s acquisitions of doctor practices and ambulatory surgical procedure facilities (ASCs) influenced affected person referral patterns and facility pricing.
What it Finds:
- Optum preferentially acquired doctor practices that already had excessive charges of ASC use, that means the acquisitions didn’t trigger a major shift of sufferers from hospital outpatient departments to inexpensive settings.
- The acquisition of 24 ambulatory surgical procedure facilities was related to an 11 % worth improve for procedures charged to competing industrial well being plans.
- This worth development was pushed by a mixture of broad will increase in facility charges and an increase in skilled charges that occurred particularly amongst Optum-employed physicians.
- In markets the place Optum owned each the referring doctor observe and the surgical procedure middle, there was no proof that vertical integration led to improved cost-savings by means of “site-of-care” shifts, regardless of the potential for such incentives.
Why it Issues
This analysis challenges the narrative that vertical integration results in a extra environment friendly healthcare system. Whereas buying entities usually declare that their buy of doctor practices and surgical procedure facilities lowers prices by steering sufferers to cheaper websites of care, this examine demonstrates that these entities might as a substitute be cherry-picking already-efficient practices after which utilizing their elevated market energy to extend costs. The 11 % worth improve for competing insurers means that such consolidation can be utilized as a device to drawback rivals, which finally drives up premiums for shoppers. Finally, the info counsel that transferring care to ambulatory settings will not be a cure-all for affordability if these settings are owned by dominant company entities.
Hospital Spending Accounted for 40% of the Development in Nationwide Well being Spending Between 2022 and 2024
Jamie Godwin, Zachary Levinson, and Tricia Neuman. KFF. February 2026. Accessible right here.
KFF researchers analyzed federal Nationwide Well being Expenditure (NHE) knowledge from 2022 by means of 2024 to determine and examine the first drivers of development throughout numerous sectors of nationwide well being spending.
What it Finds:
- Hospital care was the first driver of nationwide well being spending development between 2022 and 2024, accounting for $277 billion (40 %) of the whole $692 billion improve in spending throughout that interval.
- Worth will increase and a return to pre-pandemic utilization ranges for high-intensity providers have been cited because the main components behind the surge in hospital expenditures.
- Complete nationwide well being spending reached $5.1 trillion in 2024, with a median annual development charge of seven.3 % over the two-year interval, considerably outstripping the 5.2 % development seen within the total U.S. economic system.
- The contribution of hospital spending to complete development far exceeded different main classes, with doctor and scientific providers accounting for $96 billion (14 %) and retail prescribed drugs accounting for $88 billion (13 %) of the rise.
- Medical insurance administrative prices and income, together with authorities public well being actions, represented the second-largest share of development at 15 %, reflecting a “residual” class of spending that rose as pandemic-era packages wound down and personal market dynamics shifted.
Why it Issues:
Regardless of vital coverage give attention to drug pricing and insurance coverage firm income, the hospital sector stays probably the most substantial contributor to rising healthcare prices within the post-pandemic period. The truth that well being spending is rising at a quicker charge than the general economic system means that medical bills are consuming an ever-larger share of nationwide sources, which may crowd out different private and non-private priorities. This pattern is pushed not solely by a return to high-intensity care after years of deferred providers but additionally by persistent upward strain on the costs hospitals cost. For employers and shoppers, this shift interprets immediately into larger industrial insurance coverage premiums and elevated out-of-pocket prices.
Modifications In Medical Debt And Chapter After Acute Traumatic Accidents, 2019-21
John W. Scott et al.. Well being Affairs. February 2026. Accessible right here.
Researchers from the Universities of Washington and Michigan analyzed a statewide trauma registry linked to client credit score studies from 2019–21 to judge the impression of acute traumatic damage hospitalizations on medical debt and chapter filings.
What it Finds:
- At eighteen months post-injury, the proportion of sufferers with medical debt in collections elevated by 5.2 share factors, representing a 24 % relative improve in contrast with the pre-injury baseline.
- The typical quantity of medical debt in collections per affected person rose by $290, which marks a 76 % relative improve from the degrees recorded earlier than the traumatic occasion.
- Put up-injury chapter filings peaked at fifteen months, reaching a charge of three.2 per 1,000 sufferers and representing a 6 % relative improve over the baseline.
- Monetary hardship disproportionately affected uninsured, youthful, and lower-income people, in addition to these with non-public insurance coverage, whereas sufferers coated by Medicare and Medicaid skilled minimal adjustments of their monetary standing.
Why this Issues:
Even with the Inexpensive Care Act’s protection positive aspects, an unanticipated acute medical occasion can nonetheless trigger vital and lasting monetary instability for American households. The truth that privately insured sufferers noticed significant will increase in debt and chapter signifies that many industrial plan designs, characterised by excessive deductibles and cost-sharing, are failing to offer ample monetary safety towards traumatic damage. These monetary shocks have an extended tail, with debt and chapter filings peaking greater than a yr after the preliminary damage, suggesting that the financial fallout persists lengthy after the scientific restoration. The examine additionally exposes a stark distinction in safety throughout insurance coverage sorts, as these with Medicare and Medicaid have been largely shielded from monetary danger because of their extra beneficiant protection. These findings underscore that for a lot of Individuals, significantly the privately insured, a single emergency stays a possible catalyst for long-term collections and credit score injury.