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Impact of hospital‐physician vertical integration on physician‐administered drug spending and utilization

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  • Jonathan S. Levin
  • Xiaoxi Zhao
  • Christopher Whaley

Abstract

We estimate the effects of hospital‐physician vertical integration on spending and utilization of physician‐administered drugs for hematology‐oncology, ophthalmology, and rheumatology. Using a 100% sample of Medicare fee‐for‐service medical claims from 2013 to 2017, we find that vertical integration shifts treatments away from physician offices and toward hospital outpatient departments. These shifts are accompanied by increases in physician‐administered drug administration spending per procedure for all three specialties. Spending on Part B drugs also increases for hematologist‐oncologists. At the same time, physician treatment intensity, as measured by the number of beneficiaries who receive drug infusions/injections and the number of drug infusions, decreases across all three specialties. These results suggest that the incentives of the Medicare reimbursement system, particularly site‐of‐care payment differentials and outpatient drug reimbursement rates, interact with vertical integration to lead to higher overall spending. Policies and merger guidelines should attempt to restrain spending increases attributed to vertical integration.

Suggested Citation

  • Jonathan S. Levin & Xiaoxi Zhao & Christopher Whaley, 2025. "Impact of hospital‐physician vertical integration on physician‐administered drug spending and utilization," Health Economics, John Wiley & Sons, Ltd., vol. 34(2), pages 345-367, February.
  • Handle: RePEc:wly:hlthec:v:34:y:2025:i:2:p:345-367
    DOI: 10.1002/hec.4909
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    1. Richards, Michael R. & Seward, Jonathan A. & Whaley, Christopher M., 2022. "Treatment consolidation after vertical integration: Evidence from outpatient procedure markets," Journal of Health Economics, Elsevier, vol. 81(C).
    2. Chernew, Michael & Cooper, Zack & Hallock, Eugene Larsen & Scott Morton, Fiona, 2021. "Physician agency, consumerism, and the consumption of lower-limb MRI scans," Journal of Health Economics, Elsevier, vol. 76(C).
    3. Manasi Deshpande & Yue Li, 2019. "Who Is Screened Out? Application Costs and the Targeting of Disability Programs," American Economic Journal: Economic Policy, American Economic Association, vol. 11(4), pages 213-248, November.
    4. Jeah Jung & Roger Feldman & Yamini Kalidindi, 2019. "The impact of integration on outpatient chemotherapy use and spending in Medicare," Health Economics, John Wiley & Sons, Ltd., vol. 28(4), pages 517-528, April.
    5. Martin Gaynor & Paul Gertler, 1995. "Moral Hazard and Risk Spreading in Partnerships," RAND Journal of Economics, The RAND Corporation, vol. 26(4), pages 591-613, Winter.
    6. Koch, Thomas G. & Wendling, Brett W. & Wilson, Nathan E., 2017. "How vertical integration affects the quantity and cost of care for Medicare beneficiaries," Journal of Health Economics, Elsevier, vol. 52(C), pages 19-32.
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