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Why healthcare providers merge

Published online by Cambridge University Press:  09 May 2015

Jeroen Postma*
Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
Anne-Fleur Roos
Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
*Correspondence to: Jeroen Postma, Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. Email:


In many OECD countries, healthcare sectors have become increasingly concentrated as a result of mergers. However, detailed empirical insight into why healthcare providers merge is lacking. Also, we know little about the influence of national healthcare policies on mergers. We fill this gap in the literature by conducting a survey study on mergers among 848 Dutch healthcare executives, of which 35% responded (resulting in a study sample of 239 executives). A total of 65% of the respondents was involved in at least one merger between 2005 and 2012. During this period, Dutch healthcare providers faced a number of policy changes, including increasing competition, more pressure from purchasers, growing financial risks, de-institutionalisation of long-term care and decentralisation of healthcare services to municipalities. Our empirical study shows that healthcare providers predominantly merge to improve the provision of healthcare services and to strengthen their market position. Also efficiency and financial reasons are important drivers of merger activity in healthcare. We find that motives for merger are related to changes in health policies, in particular to the increasing pressure from competitors, insurers and municipalities.

© Cambridge University Press 2015 

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Actiz (2012), De Verpleeg- en Verzorgingshuiszorg en Thuiszorg in Kaart (Overview of Nursing Homes, Elderly Homes and Home Care Organizations), Amsterdam: De Argumentenfabriek.Google Scholar
Angeli, F. and Maarse, H. (2012), ‘Mergers and acquisitions in Western European health care: exploring the role of financial service organizations’, Health Policy, 105(2): 265272.CrossRefGoogle Scholar
Angwin, D. (2007), ‘Motive archetypes in mergers and acquisitions (M&A): the implications of a configurational approach to performance’, Advances in Mergers and Acquisitions, 6: 77105.Google Scholar
Barro, J. R. and Cutler, D. M. (1997), ‘Consolidation in the Medical Care Marketplace: A Case Study from Massachusetts’, Working Paper 5979, National Bureau of Economic Research Working Paper Series, Cambridge.Google Scholar
Bazzoli, G. J., LoSasso, A., Arnould, R. and Shalowitz, M. U. (2002), ‘Hospital reorganization and restructuring achieved through merger’, Health Care Management Review, 27(1): 720.Google Scholar
Bigelow, B. and Arndt, M. (2000), ‘The more things change, the more they stay the same’, Health Care Management Review, 25(1): 6572.Google Scholar
Blank, J., Haerlermans, C., Koot, P. and van Putten-Rademaker, O. (2008), Schaal en Zorg: Een inventariserend onderzoek naar de relatie tussen schaal, bereikbaarheid, kwaliteit en doelmatigheid in de zorg’ (Scale and Healthcare: An Exploratory Study on the Relation Between Organizational Scale, Accessibility, Quality and Efficiency in Healthcare), Den Haag: RVZ.Google Scholar
Bogue, R. J., Shortell, S. M., Sohn, M.-W., Manheim, L. M., Bazzoli, G. J. and Chan, C. (1995), ‘Hospital reorganization after merger’, Medical Care, 33(7): 676686.Google Scholar
Brooks, G. R. and Jones, V. G. (1997), ‘Hospital mergers and market overlap’, Health Services Research, 31(6): 701722.Google Scholar
Carey, K., Burgess, J. Jr and Young, G. (2011), ‘Hospital competition and financial performance: the effects of ambulatory surgery centers’, Health Economics, 20(5): 571581.Google Scholar
Choi, S. and Brommels, M. (2009), ‘Logics of pre-merger decision-making processes: the case of Karolinska University Hospital’, Journal of Health, Organization and Management, 23(2): 240254.Google Scholar
Comtois, E., Denis, J.-L. and Langley, A. (2004), ‘Rhetorics of efficiency, fashion and politics’, Management Learning, 35(3): 303320.Google Scholar
Cutler, D. M. (2009), ‘The next wave of corporate medicine – how we all might benefit’, The New England Journal of Medicine, 316(6): 549551.Google Scholar
Dranove, D. and Shanley, M. (1995), ‘Cost reductions or reputation enhancement as motives for mergers: the logic of multihospital systems’, Strategic Management Journal, 16(1): 5574.Google Scholar
Fabbricotti, I. N. (2007), ‘Zorgen voor Zorgketens’ (Taking Care of Integrated Care), PhD thesis, Erasmus University Rotterdam, Rotterdam.Google Scholar
Fulop, N., Protopsaltis, G., Hutchings, A., King, A., Allan, P., Normand, C. and Walters, R. (2002), ‘Process and impact of mergers of NHS trusts: multicentre case study and management cost analysis’, British Medical Journal, 325(7358): 17.Google Scholar
Garside, P. (1999), ‘Evidence based mergers? Two things are important in mergers: clear goals, clearly communicated’, British Medical Journal, 318(7180): 345346.Google Scholar
Gaynor, M. and Haas-Wilson, D. (1999), ‘Change, consolidation, and competition in health care markets’, The Journal of Economic Perspectives, 13(1): 141164.Google Scholar
Gaynor, M. and Town, R. J. (2012), ‘Competition in Health Care Markets’, in T. McGuire, M. V. Pauly and P. Pita Barros (eds), Handbook of Health Economics, Chapter 9, Volume 2. Amsterdam: Elsevier North-Holland, 499638.Google Scholar
Gaynor, M., Moreno-Serra, R. and Propper, C. (2013), ‘Death by market power: reform, competition, and patient outcomes in the National Health Service’, American Economic Journal: Economic Policy, 5(4): 134166.Google Scholar
Harris, J., Ozgen, H. and Ozcan, Y. (2000), ‘Do mergers enhance the performance of hospital efficiency?’, The Journal of the Operational Research Society, 51(7): 801811.Google Scholar
Harrison, T. D. (2007), ‘Consolidations and closures: an empirical analysis of exits from the hospital industry’, Health Economics, 16(5): 457474.Google Scholar
Harrison, J. P., McCue, M. J. and Wang, B. B. (2003), ‘A profile of hospital acquisitions’, Journal of Healthcare Management, 48(3): 156170.Google Scholar
Hayford, T. B. (2012), ‘The impact of hospital mergers on treatment intensity and health outcomes’, Health Services Research, 47(3.1): 10081029.Google Scholar
Helderman, J.-K., Schut, F. T., Van der Grinten, T. E. D. and Van de Ven, W.P.M.M. (2005), ‘Market-oriented healthcare reforms and policy learning in the Netherlands’, Health Politics, Policy and Law, 30(1–2): 189209.Google Scholar
Kitchener, M. (2002), ‘Mobilizing the logic of managerialism in professional fields: the case of academic health centre mergers’, Organization Studies, 23(3): 391420.Google Scholar
Kroneman, M., Cardol, M. and Friele, R. (2012), ‘(De)centralization of social support in six Western European countries’, Health Policy, 106(1): 7687.Google Scholar
Mosca, I. and Heijink, R. (2013), ‘De curatieve GGZ: effecten van het beleid sinds 2008’ (Curative mental health: effects of policy since 2008), Maandblad Geestelijke Volksgezondheid, 68(5): 194202.Google Scholar
NZa (Dutch Healthcare Authority) (2010), Monitor de curatieve GGZ in 2009 (Monitor: Curative Mental Healthcare in 2009), Utrecht: NZa.Google Scholar
NZa (Dutch Healthcare Authority) (2012a), Monitor Zelfstandige Behandelcentra: Een kwalitatieve en kwantitatieve analyse (Monitor Independent Treatment Centres: A Qualitative and Quantitative Analysis), Utrecht: NZa.Google Scholar
NZa (Dutch Healthcare Authority) (2012b), Marktscan Intramurale AWBZ. Weergave van de markt 2010–2011 (Marketscan Inpatient Long-term Care 2010–2011), Utrecht: NZa.Google Scholar
NZa (Dutch Healthcare Authority) (2013), Marktscan Medisch specialistische zorg. Weergave van de markt 2009–2013 (Marketscan Medical Specialist Care 2009–2013), Utrecht: NZa.Google Scholar
NZa (Dutch Healthcare Authority) (2014a), Marktscan Geestelijke Gezondheidszorg. Weergave van de markt 2009-2013 (Marketscan Mental Healtcare 2009–2013), Utrecht: NZa.Google Scholar
NZa (Dutch Healthcare Authority) (2014b), Marktscan Zorgverzekeringsmarkt 2014. Weergave van de markt 2010–2014 (Marketscan Health Insurance Market 2010–2014), Utrecht: NZa.Google Scholar
Noordegraaf, M., Meurs, P. and Montijn-Stoopendaal, A. (2005), ‘Pushed organizational pulls’, Public Management Review, 7(1): 2543.CrossRefGoogle Scholar
Oldenhof, L., Postma, J. and Putters, K. (2014), ‘On justification work: how compromising enables public managers to deal with conflicting values’, Public Administration Review, 74(1): 5263.Google Scholar
Pommer, E., van der Torre, A. and Eggink, E. (2009), Definitief advies over het Wmo-budget huishoudelijke hulp voor 2009 (Final Recommendation on Wmo-budget for Household Services), Den Haag: SCP.Google Scholar
Postma, J., van den Bovenkamp, H. and Putters, K. (forthcoming), The social construction of organizational scale.Google Scholar
Propper, C. (2012), ‘Competition, incentives and the English NHS’, Health Economics, 21(1): 3340.Google Scholar
Putters, K., Grit, K., Janssen, M., Schmidt, D. and Meurs, P. (2010), Governance of Local Care & Social Service, Rotterdam: Institute of Health Policy and Management.Google Scholar
RIVM (National Institute for Health and Environment) (2013), Volksgezondheid Toekomst Verkenning, Nationale Atlas Volksgezondheid. (The Dutch Public Health Status and Forecasts Report), Bilthoven: RIVM.Google Scholar
Robinson, J. C. (1998), ‘Consolidation of medical groups into physician practice management organizations’, Journal of the American Medical Association, 279(2): 144149.Google Scholar
Saltman, R. B., Allin, S., Mossialos, E., Wismar, M. and Kutzin, J. (2012), ‘Assessing Health Reform Trends in Europe’, in J. Figueras and M. McKee (eds), Health System, Health, Wealth and Societal Well-Being: Assessing the Case of Investing in Health Systems, Berkshire: McGraw Hill, Open University Press, 209246.Google Scholar
Schut, F. T. and van den Berg, B. (2010), ‘Sustainability of comprehensive universal long-term care insurance in the Netherlands’, Social Policy & Administration, 44(4): 411435.Google Scholar
Spang, H. R., Bazzoli, G. J. and Arnould, R. J. (2001), ‘Hospital mergers and savings for consumers: exploring new evidence’, Health Affairs, 20(4): 150158.Google Scholar
Te Boekhorst, S. (2010), ‘Group Living Homes for Older People with Dementia’, PhD thesis, Ponsen & Looijen b.v, Wageningen.Google Scholar
Trimbos-instituut (2011), Trendrapportage GGZ 2011 (Report of Trends in Mental Care 2011), Utrecht: Trimbos-instituut.Google Scholar
Tweede Kamer (Dutch Parliament) (2013), Toekomst AWBZ (Future of AWBZ) 30597(296) Den Haag: Tweede Kamer.Google Scholar
van der Scheer, W. (2007), ‘Is the new health-care executive an entrepreneur?’, Public Management Review, 9(1): 4965.Google Scholar
van de Ven, W. P. M. M. and Schut, F. T. (2009), ‘Managed competition in the Netherlands: still work-in-progress’, Health Economics, 18(3): 253255.Google Scholar
Varkevisser, M., van der Geest, S. A. and Schut, F. T. (2007), Concurrentie in de thuiszorg. Een analyse van de juridische en economische context (Competition in Home Care. An Analysis of the Legal and Economic Context), Rotterdam: Erasmus Competition and Regulation Institute (ECRI).Google Scholar
Vogt, W. B. and Town, R. (2006), ‘How has Hospital Consolidation Affected the Price and Quality of Hospital Care?’, Robert Wood Johnson Foundation Research Synthesis Report No. 9. Princeton.Google Scholar
Witman, Y., Smid, G. A. C., Meurs, P. L. and Willems, D. L. (2011), ‘Doctor in the lead: balancing between two worlds’, Organization, 18(4): 477495.Google Scholar