The analysis included a total of 580 health systems that accounted for 40 percent of physicians and 84 percent of general acute care hospital beds. Academic and large nonprofit systems accounted for a majority of system physicians (80 percent) and system hospital beds (64 percent).

System hospitals were larger than hospitals that were not part of a system, with 67 percent of system hospitals having more than 100 beds, while only 23 percent of nonsystem hospitals having more than 100 beds. System physician practices likewise were more likely to have more than 100 physicians compared with nonsystem practices (74 percent vs. 12 percent). Integrated systems delivered primary care to 41 percent of traditional Medicare beneficiaries; which does not include people enrolled in Medicare Advantage programs.


Next, the researchers analyzed the quality and cost of care delivered within systems. Their findings suggest that patients whose primary care physicians are part of health systems, on average, receive marginally better care and report slightly better experiences with the health care delivery system, compared with patients whose primary care physicians are part of independent practices.

This is the case even though many patients with nonsystem primary care providers also receive some of their care in hospitals or specialist practices that are part of a health system. However, care in systems came at a much higher price, contributing to higher overall spending on health care, the research showed.

Prices for services from physicians and hospitals within health systems were significantly higher than the prices of services from independent physicians and hospitals, the study found. Physician services delivered within health systems cost between 12 percent and 26 percent more, compared with independent practices. System-based hospital services cost 31 percent more, on average, compared with care delivered by independent hospitals.

Small differences in quality combined with large differences in cost of care suggests that health systems have not, on average, realized their potential for better care at equal or lower cost, the researchers said.

Members of the research team have compiled a database from various sources to help characterize these health systems and to link claims data with information on health care providers in and out of health systems. The database, housed at NEBR, will be made available for free to other researchers in the near future.

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