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ACM: hospital mergers do not demonstrably improve health care quality

Mergers between hospitals have not demonstrably helped improve health care quality. This has been the conclusion of a study that was commissioned by the Netherlands Authority for Consumers and Markets (ACM) into the quality effects of 14 hospital mergers in the period of 2007-2013.

It has already been known that mergers often do not produce the desired or expected result. And this is also true for hospital mergers. Hospital executives often use the argument that the merger will benefit patients as it supposedly improves health care quality. However, the results of this study do not corroborate that line of reasoning.


On the basis of the study, ACM has formulated the following recommendations:

  1. If hospitals put forward quality benefits as an argument, ACM will critically assess these in its merger assessment. For hospitals, this means that, in any case, they need to substantiate concretely and in detail the expected quality benefits;
  2. Further development of quality indicators that are unequivocal, accessible, and easy-to-understand continues to be necessary, and ACM will support such initiatives;
  3. When seeking to achieve the desired quality benefits, hospitals should consider less far-reaching forms of collaborations more often.

What effects did the study examine?

ACM sought to get a better overview of the quality effects of hospital mergers. To that end, ACM had a study carried out into how quality levels of 14 merged hospitals evolved over time, compared with those of non-merged hospitals. Using 97 quality indicators, including health care-based factors such as patient experiences, waiting times, and mortality rates, these trends have been compared with each other.

How are hospital mergers assessed by ACM?

In its assessments of hospital mergers, ACM must answer the question of whether sufficient choice and competition will remain in the market after the planned merger. After all, sufficient competition creates an incentive to compete on quality and price. If insufficient competition remains in the market, ACM will block the merger. A merger could still be cleared, despite a lack of competition, only if it were to bring about real improvement to health care quality. In that case, however, the burden of proof lies with the hospitals, and they need to take the initiative. The expected improvements in quality must offset the drawbacks of higher prices or reduced accessibility.

Study into price effects of hospital mergers

In addition to the study into the quality effects of hospital mergers, which has been published today, ACM is currently also studying the price effects of hospital mergers. The results of this study are expected to be released in early-2017. As soon as the results are known, ACM will be able to get a more complete picture of the effects of hospital mergers, as well as of any implications for the way such mergers are assessed. Also, a bill has been submitted to the Dutch House of Representatives, proposing changes of several aspects of health care oversight.