designing antitrust and other regulatory policies.” 57 Surgeon and health policy essayist Atul Gawande opines:
I think there are actually two major concerns—one is that monopolies raise prices, and the second is that monopoly means you also lose the pressure on quality of care. When patients don’t have elsewhere to go, the pressure on the system to ensure they have quality is also just as affected as the prices. 58
Some economists remain skeptical about the degree to which increased competition brings about the optimal level of quality in health services delivery in the first place. 59 Certainly, reliable empirical research findings on the competition-quality relationship in the LTSS arena specifically, are quite sparse, as most of the limited research in this arena has concentrated on hospitals. Moreover, usefully evaluating the quality of LTSS is a complicated proposition. 60 Besides measuring descriptive performance,
[W]e should find ways to measure and systematically collect information on adequacy and appropriateness of care and the consumers’ level of integration, control, participation, and general well-being….It is essential that we also assess the impact of LTSS on ‘quality of life’ (e.g., comfort, meaningful activity, relationships, enjoyment, dignity, autonomy, privacy, individuality, spiritual well-being, and functional competence) as well as its ability to promote a sense of safety, security, and order. 61
Another aspect of quality of care concerns continuity, a matter of particular importance to those many LTSS consumers who use the services of multiple providers in multiple care settings. 62 The American Academy of
57. Gautam Gowrisankaran, Competition, Information Provision, and Hospital Quality, in INCENTIVES AND CHOICE IN HEALTH CARE 319, 343 (Frank A. Sloan & Hirschel Kasper, eds., 2008). 58. Robert A. Berenson, Is Bigger Better? The Implications of Health Care Provider Consolidation: An Interview With Atul Gawande, ROBERT WOOD JOHNSON FOUND. 4 (Oct. 2014), http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2014/rwjf415751. 59. See FRANK A. SLOAN & HIRSCHEL KASPER, Summing Up, in INCENTIVES AND CHOICE
IN HEALTH CARE 357, at 358-59 (explaining that more research is necessary before economists will be able to generalize about the relationship between competition and the quality of care). 60. See generally Gary Claxton et al., Measuring the Quality of Healthcare in the U.S., PETERSON-KAISER HEALTH SYSTEM TRACKER (Sept. 10, 2015), http:// www.healthsystemtracker.org/insight/measuring-the-quality-of-healthcare-in-the-u- s/?utm_campaign=peterson. 61. Kali S. Thomas & Robert Applebaum, Long-Term Services and Supports (LTSS): A Growing Challenge for an Aging America, 25 PUB. POL’Y & AGING REP. 56, 60 (2015). 62. See generally Paul Saucier et al., Consumer Choices and Continuity of Care in Managed Long-Term Services and Supports: Emerging Practices and Lessons, AARP PUB. POL’Y INST. (2013), http://www.aarp.org/content/dam/aarp/research/public_policy_institute/ ltc/2013/consumer-choices-report-full-AARP-ppi-ltc.pdf.