Concentration and Integration of Medical Services Provided in the International and Russian Health Care: Is There an Increment in Effect?

The paper addresses the issue of the interrelationship between concentration of service delivery market and integration of individual medical services, measured by indicators of team work, coordination and continuity of care in outpatient and inpatient facilities. The review of the international experience indicates the growth of concentration with the major forms of hospital and hospital-physician complexes. However, the integrative activities are implemented not in all complexes and to a limited extent. There is some empirical evidence of the positive impact of a greater size of hospitals on the quality of care and unit cost reduction per hospital admission, but there is no clear-cut evidence of the positive impact of medical complexes on their performance. In Russia, the scale of the concentration is also substantial. The paper addresses specific forms of this process and its outcome. It is concluded that consolidation and mergers of health providers do not improve the performance of large medical complexes, although they have a potential for restructuring service delivery. This outcome can be attributed to the weakness of the actual integrative activities. Sociological surveys of physicians demonstrate a low level of providers interaction. The authors provide recommendations on the process of concentration management, of which the most important is the need for better substantiation of health providers mergers and the focus on reaching actual integration of service delivery. The results of the research may be of interest to health policy experts and health authorities of all levels.