Hospitals Swallowing Independent Practices—New Research Finds the Vertical Integration Leads to Higher Costs, Worse Patient Health Outcomes

INFORMS Journal Management Science New Study Key Takeaways:

  • Physicians significantly alter care processes after vertical integration.
  • Vertical integration negatively affects healthcare quality and overall physician spending.
  • Integration increases the number of patients a physician can treat and elevates reimbursement per procedure.


BALTIMORE, MD, August 31, 2023 – It’s been adopted more regularly across U.S. healthcare systems – vertical integration is when physicians work directly for hospitals rather than independent practices. The intention is to have positive outcomes for patients, but new research forthcoming in the INFORMS journal Management Science finds that vertical integration is leading to higher costs and worse health outcomes, thanks to improperly aligned financial incentives.

The study, “The Impact of Vertical Integration on Physician Behavior and Healthcare Delivery: Evidence from Gastroenterology Practices,” looks at data of Medicare patients treated by gastroenterologists, a specialty with a recent increase in vertical integration. 

“We find that physicians significantly alter care processes after they vertically integrate, and that patients’ post-procedure complications increase substantially,” says Soroush Saghafian of Harvard University. “We provide evidence that the financial incentive structure of the integrated practices is the main reason for the changes in physician behavior since it discourages the integrated practices from allocating expensive resources to relatively unprofitable procedures.”

Saghafian, alongside fellow co-authors Lina Song of University College London, Joseph Newhouse, John Hsu and Mary Beth Landrum (all of Harvard University), found that although integration improves operational efficiency measured by physicians’ throughput, it negatively affects patient care quality and overall spending.

The researchers say that integration increased the number of patients a physician was able to treat and elevated reimbursement per procedure. For example, integrated doctors were reimbursed about $127 more per colonoscopy procedure than independent doctors, or about 48% more.

“We recommend policymakers correct the incentive system currently in place by paying more for services. This additional expense would result in improvements to both patient well-being and the volume of patients cared for, and therefore would provide notable savings in the long term,” says Saghafian, an associate professor of public policy in the Harvard Kennedy School.

These findings prove that integrated practices don’t necessarily achieve superior patient outcomes.

“There should be measures to monitor post-integration behavior and quality, and align with post-integration incentives. Given how fast vertical integration is happening, it’s important for lawmakers to take quick, logical action now.”



Link to full study.


About INFORMS and Management Science

Management Science is a premier peer-reviewed scholarly journal focused on research using quantitative approaches to study all aspects of management in companies and organizations. It is published by INFORMS, the leading international association for operations research and analytics professionals. More information is available at or @informs.





Ashley Smith


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Hospitals Swallowing Independent Practices—New Research Finds the Vertical Integration Leads to Higher Costs, Worse Patient Health Outcomes

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Ashley Smith
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