Capitation and consolidation
This thesis analyzes how a change in reimbursement model from Fee-For-Service (FFS) to a bundled payment model affects firm sizes in the dialysis market from 2007 to 2020. This work aims to provide context as to how bundled payment and other capitation policies may affect healthcare markets in unexpected ways. This thesis will assess the state of the dialysis market through a comparison of its current state to perfect competition economic principles. The Background section will provide readers with an overview of the dialysis industry as well as recent policy changes in the dialysis reimbursement. The Methods section describes why a comparative interrupted time series analysis (CITSA) was chosen, and explains all variables and analyses utilized to produce a picture of the dialysis markets changes over time, using number of facilities owned by two different categories of firms annually. The Results section reports average changes in facility ownership by firm grouping over in both the pre and post-treatment periods, and examines the differences in the trends of both groups, concluding that significant consolidation has taken place in the dialysis market. The Discussion interprets the results of the analysis and expands on recent trends of capitation and consolidation in healthcare markets. The Conclusion of this research gives recommendation for future research and policy that could be crucial to protect Americans from rising healthcare prices and unnecessary care costs, given the rates of consolidation in healthcare and the amount of markets that are already highly concentrated.