The US’s for-profit hospital sector concentration[La concentration du secteur hospitalier à but lucratif aux États-Unis]

Concentration in the for-profit hospital sector is an international phenomenon. Given its limited exploration in French economic literature, our focus here is on the most extensively studied country: the United States, where the integration process began in the early 1960s. Neoclassical literature perceives concentration as a means to achieve a second-best equilibrium in a market that is imperfect due to the specific characteristics of healthcare. Concentration results from the implementation of "social institutions" aimed at approaching this second-order equilibrium. Empirical studies seek to assess the improved efficiency derived from concentration: While concentration reduces costs, the origins of this consequence remain poorly understood; moreover, reduced costs do not result in price cuts, instead, hospitals and groups often gain market power, leading to the opposite effect. Political economy studies for-profit hospital development and concentration as the result of relatively advantageous institutional conditions, especially through generous payments. Freedom of exercise allows for-profit hospitals to evolve through tariff regulation as a consequence of distributional conflicts.