Vertical integration in healthcare: What does literature say about improvements on quality, access, efficiency, and costs containment?

• Published in: The International journal of health planning and management 2022-05, Vol.37 (3), p.1252-1298
• Main Authors: Amado, Guilherme C., Ferreira, Diogo C., Nunes, Alexandre M.
• Format: Article
• Language: English
• Subjects: Access; Acute services; Containment; Continuity of care; Cost analysis; Cost Control; Costs; Delivery of Health Care; Efficiency; efficiency and cost containment; Health care; Health care expenditures; Health Facilities; Health Personnel; Humans; Inclination; Integrated care; Integration; literature review; Literature reviews; Prices; Primary care; quality; Quality of care; Vertical integration; vertical integration in healthcare
• ISSN: 0749-6753; 1099-1751
• DOI: 10.1002/hpm.3407

Introduction Vertical integration models involve integrating services from different levels of care (e.g., primary care, acute care, post‐acute care). Therefore, one of their main objectives is to increase continuity of care, potentially improving outcomes like efficiency, quality, and access or even enabling cost containment. Objectives This study conducts a literature review and aims at contributing to the contentious discussion regarding the effects of vertical integration reforms in terms of efficiency, costs containment, quality, and access. Methods We performed a systematic search of the literature published until February 2020. The articles respecting the conceptual framework were included in an exhaustive analysis to study the impact of vertical integration on costs, prices of care, efficiency, quality, and access. Results A sample of 64 papers resulted from the screening process. The impact of vertical integration on costs and prices of care appears to be negative. Decreases in technical efficiency upon vertical integration are practically out of the question. Nevertheless, there is no substantial inclination to visualise a positive influence. The same happens with the quality of care. Regarding access, the lack of available articles on this outcome limits conjectures. Conclusions In summary, it is not clear yet whether vertically integrated healthcare providers positively impact the overall delivery care system. Nevertheless, the recent growing trend in the number of studies suggests a promising future on the analysis of this topic. Highlights We review literature concerning performance of vertical integration in healthcare; We evaluated quality, access, efficiency, and costs containment; The vertical integration impact on costs and prices of care appears to be negative; There is no substantial inclination to visualise a positive influence over quality; Regarding access, the lack of available articles on this outcome limits conjectures.