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Concentration of health care providers: does it contribute to integration of service delivery?

Authors Sheiman I, Shevsky V

Received 19 February 2019

Accepted for publication 19 June 2019

Published 7 August 2019 Volume 2019:12 Pages 153—166

DOI https://doi.org/10.2147/RMHP.S205905

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Ms Justinn Cochran

Peer reviewer comments 2

Editor who approved publication: Dr Kent Rondeau


I Sheiman, V Shevsky

Department of State and Municipal Administration, The National Research University Higher School of Economics, Moscow, Russia

Background: The concentration of health care providers is a growing process in many countries, including Russia. There is a general expectation that larger medical entities can better promote the process of service integration.
Purpose: This paper explores the impact of health provider concentration on service delivery integration through the indicators of teamwork, coordination and continuity of care in outpatient and inpatient medical facilities. These developments in Russia are compared with international experience.
Methods: National and international literature on health services concentration and integration is reviewed; statistical analysis is based on Russian national data, WHO and OECD databases; a sociological survey of Russian physicians and interviews with managers of medical facilities are used to evaluate the value of integration.
Results: The review of international trends indicates a growing process of mergers to form large hospital and physician-hospital systems, particularly in the USA. Enhanced clinical and administrative integration is usually seen as the logical outcome of concentration. However, growing international empirical estimates demonstrate a controversial impact of concentration on quality of medical care, unit cost (per patient) and integration of care. In Russia, the establishment of consolidated health systems is coupled with an increase in the average size of hospitals, while the number of free-standing providers has substantially decreased. The effect of concentration in the country is also controversial. There is some evidence of its positive impact on restructuring service delivery and the accessibility to some services, but the surveys of physicians don’t demonstrate improvement in the organization of service delivery, nor closer links between providers. Surveys of providers don’t provide evidence of teamwork, coordination and continuity of care in consolidated settings.
Conclusion: There are many deeply rooted barriers to integration in Russia, of which the most important is the lack of clear objectives of providers mergers. The major lesson learnt is that in the country with limited financial resources, decisions on provider concentration should be carefully justified with the focus on the specific integrative activities. National health policy for integration should be a major pre-condition for the positive impact of concentration on integration.

Keywords: concentration of health providers, integration of service delivery, Russian health care, teamwork, coordination of care, continuity of care


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