AHRQ Views: Blog posts from AHRQ leaders
With AHRQ’s New Compendium, Researchers and Policymakers Gain Fresh Insights into Nation’s Health Systems
The architecture of health care delivery in America is undergoing significant changes. Networks of private hospitals, clinics, and medical practices have consolidated in ways that are impacting the care patients receive on a day-to-day basis. The proliferation of health systems is linked to several factors, including the advent of Accountable Care Organizations, bundled payments, and quality-based payment incentives.
Thus far, however, the health services research community has lacked a publicly available data resource that might shed light on the Nation’s health systems and the role they play in areas such as health care quality and patient safety.
AHRQ is extremely excited, therefore, to provide the Compendium of U.S. Health Systems, 2016—the first publicly available database that provides researchers, policymakers, and health care administrators with a snapshot of the Nation’s health systems. For this purpose, we have defined health systems as networks of at least one hospital connected via ownership to one or more physician groups.
The compendium shows:
- By the end of 2016, there were 626 private health systems in the United States.
- About 70 percent of U.S. non-Federal general acute care hospitals are in health systems.
- Hospitals in these health systems account for roughly 88 percent of U.S. hospital beds and 92 percent of U.S. hospital discharges.
- Nearly 45 percent of U.S. physicians are in these systems.
- Nearly 75 percent of all U.S. hospitals that serve a high proportion of low-income patients are in these systems.
The data also show considerable variations in the size of health systems. About half include fewer than 3 hospitals and less than 250 physicians. A small number of systems, meanwhile, are characterized by many more hospitals and physicians.
The compendium exemplifies the Agency’s ongoing commitment to collect, analyze, and disseminate data in ways that support quality improvement efforts. It was developed through AHRQ’s Comparative Health Systems Performance (CHSP) Initiative.
The CHSP Initiative is a collaboration among researchers at Dartmouth College, the National Bureau of Economic Research, and RAND to examine systems’ use of evidence-based medicine and explore factors that contribute to high performance. Mathematica Policy Research is supporting coordination of the initiative.
The compendium will evolve over time. It currently provides a 2016 list of health systems developed with data from sources that cover the entire U.S.: the American Hospital Association Annual Survey Database, 2015; QuintilesIMS™ Healthcare Organization Services (OneKey Organizations [HCOS]), 2016; and the SK&A Healthcare Databases, 2016.
AHRQ acknowledges the need to consider alternative definitions of health systems. CHSP Initiative collaborators, in fact, have developed distinct definitions that were developed to support their individual areas of interest.
The Agency also understands the limitations of the compendium’s definition. The requirement of “at least one hospital,” for example, excludes some organizations that provide care without an ownership or tight co-management relationship with a hospital. New data and information, however, may result in a revised definition.
But even with these limitations, we believe there is value in the research that will result from the release of the compendium. The compendium will be updated regularly so that policymakers, health system leaders, payers, and others can track trends over time. We are making these data publicly available, and we encourage researchers to initiate their own investigative projects.
Our new series of Data Highlights publications will provide periodic digests of updated health systems data. Likewise, our CHSP Initiative web pages will offer links to new journal publications authored by CHSP Initiative collaborators.
By working with some of the Nation’s leading experts on health systems, AHRQ is opening doors to an area that plays an increasingly important role in today’s delivery of care. We hope you’ll follow our progress as we continue to learn more!
Dr. Arnold is Deputy Director of AHRQ.