Kristof Stremikis with the California Health Care Foundation speaks at HJ25. Photo by Zachary Linhares
How hospital mergers harm local communities
By Jon Harris, New York Health Journalism Fellow
When investigative reporter George Joseph started pursuing a story on medical debt, an expert advised him to focus on high medical prices driven by hospital mergers that create market concentration.
The result was an investigative series, “Too big to care.” Using this reporting example, panelists at Health Journalism 2025 explained to journalists how to dig into hospital mergers to expose its effects on local communities.
It’s a topic rife with reporting opportunities. Consider: Between 1998 and 2021, almost 2,000 hospital transactions have unfolded, and most community hospitals are now controlled by multi-region health systems, said Lovisa Gustafsson, MBA, vice president of the Controlling Health Care Costs program at The Commonwealth Fund.
Patients in nearly half of all metropolitan areas only have one or two hospital systems providing inpatient care, she added. That market share concentration gives health systems leverage in negotiations with health insurers and the power to demand higher prices, Gustafsson said.
And when hospitals merge, health care prices can increase 20% to 30% with minimal-to-no difference in care quality, noted Kristof Stremikis, MPH, director of market analysis and insight at the California Health Care Foundation.
Stremikis encouraged journalists to dig into the entity behind the hospital merger for clues on what changes to access, quality and costs could come next. For instance, a Catholic health system acquiring a medical facility could bring changes around reproductive health care at the entity being absorbed, he added.
While the research is crucial, panelists said providing the stories of patients — and connecting those tales to flaws in the system — move policymakers and give them the ammunition to implement legislative fixes.
That’s what Joseph and his team did at The Guardian. The series honed in on Indiana-based Parkview Health, a rapidly expanding health system that has some of the highest hospital prices in the country despite being based in one of the most affordable markets: Fort Wayne, Ind.
Joseph dug into court records and financial disclosures on EMMA, allowing him to see every bond the state or county had issued on behalf of Parkview as the health system expanded.
He also talked to former employees of Parkview and rival health systems, which helped to tell the story of how the hospital had acquired doctors’ practices, jacked up prices and routed patient referrals to their flagship hospitals and away from nearby independent community hospitals.
Crucially, Joseph found real people hurt by Parkview’s revenue-focused practices, including a 26-year-old pregnant woman who showed up looking pale at a hospital recently acquired by Parkview.
Because Parkview hadn’t approved 24/7 ultrasound coverage for that hospital, the woman had to be transferred to a regional hub. In transit, one of her fallopian tubes ruptured.
“The central hospital did as much as they could to take care of her,” Joseph said, “but she never woke up again because she had lost too much blood.”
Jon Harris is the health care reporter at The Buffalo News.