Film and Discussion Explore What Happens When Large Health Care Systems Dominate

The Solomon Center for Health Law and Policy hosted a screening of the documentary film InHospitable, which illuminates the issue of accessing affordable health care in markets and regions increasingly dominated by large health care systems. A panel discussion followed.

The film follows a group of patients and grassroots organizers as they work to hold a multi-billion-dollar hospital system accountable for prioritizing profit over community benefit and patient care. That system is UPMC in Pittsburgh. Like many hospital systems across the U.S., UPMC has spent considerable money and time acquiring other hospitals and practices in an effort to increase their share of, and leverage within, the health care market. Advocates for affordable health care tend to focus on insurance providers and pharmaceutical companies as the malefactors; InHospitable attempts to shine a spotlight on the hospitals as part of the problem. During the COVID-19 pandemic, the trend of large nonprofit hospital systems only worsened, health care experts have noted. InHospitable tells the story of grassroots movements fighting against this trend. 

Panelists at the March 8 event were Aneri Suthar, YSPH ’23, moderator; Zack Cooper, Associate Professor of Public Health (Health Policy), Associate Professor of Economics, and Associate Professor in the Institution for Social and Policy Studies; Natasha Ray, Director, New Haven Healthy Start; and Reshma Ramachandran, Assistant Professor of Medicine (General Medicine), Co-Director, CRRIT.

In the post-film discussion, panelists spoke about market forces that incentivize hospital systems like UPMC to focus on consolidation and acquisition, especially when studies show that consolidation has a negative effect on the cost of health care. Panelists explained that while several states are addressing problem systems with more monitoring and regulations, hospital systems and their leadership are finding many ways to work around these barriers. 

Ramachandran discussed how hospitals avoid community accountability. For example, hospitals might obscure the time and location of community town halls or fail to use data and feedback to improve the patient experience if it requires extra costs. She also offered examples of systems pushing primary care practices into inaccessible neighborhoods, illustrating how decisions within the health care industry often seem ill-considered and haphazard to advocates of affordable health care.

Cooper posited that consolidation further exacerbates health care reform because it decreases competition, which has a chilling effect on how high-cost hospitals provider lower cost of care.

Ray drew from her experience at New Haven Healthy Start to discuss how health care pricing impacts New Haven residents, particularly those who are low-income and/or people of color. She urged health care leaders to engage with patients and their advocates and include them in decision making. She said that patients and advocates should be included in day-to-day clinical care decisions and “at the table” with leadership at nonprofit health care organizations. 

Ramachandran continued on the topic of representation. Even within health care boards and committees, she said, the right mix of providers is not always present. For example, there may be an overrepresentation of specialists and too few too few primary care providers in many discussions. She explained without enough clinicians, who often carry the largest burden of administrative work and tasks related to quality improvement, boards and committees don’t hear from those who have the most potential to inform and direct leadership to focus on care delivery.
 
Cooper wrapped up the discussion by reiterating the need to be thoughtful and base decisions on evidence. He reminded everyone that there are important trade-offs when trying to motivate and empower health care leaders to make decisions that work best for their organizations and patients.