Son las organizaciones de salud lideradas por proveedores demasiado grandes como para fallar? – HealthAffairs

Are Provider-Led Health Care Networks Too Big To Fail?

Are provider-led health care networks equipped to function like insurance companies? Do they have the expertise and experience to assess population health risks and costs and to accurately price health insurance products? The answer is no, and the current effort to consolidate providers and make them into ersatz insurers is a prescription for disaster.

The Affordable Care Act (ACA) is driving health care providers to combine into large health systems and to take on risk — i.e., to provide care for a specific problem or comprehensive care for a period of time, with the proviso that if costs exceed predetermined payment amounts, providers will bear the losses, and if costs are less, providers will keep the profits. Three ACA architects wrote in a 2010Annals of Internal Medicine article that the legislation was intended to “lead to vertical integration of providers and accelerate physician employment by hospitals and aggregation into large physician groups” on the theory that consolidation, coupled with assumption of financial risk, will incentivize providers to decrease unnecessary services, cut costs, and improve outcomes.

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2010 © Foro Latinoamericano Colaborativo en Calidad y Seguridad en Salud

Desarrollado por IECS (Instituto de Efectividad Clínica y Sanitaria)

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