[yborg]

This summer I made the mistake of going to a large dermatology practice with several locations because a dermatologist I had seen a few times before was unavailable. I had what turned out to be essentially contact dermatitis. The large corporate practice ended up billing almost $900 for this including an unnecessary biopsy. I assumed that this was simply a rogue practice, but this news story makes me see this in a new light. Apparently the field of dermatology has been identified as a lucrative profit center by P/E firms and these sort of dermatology practices are being built up to strip mine the out of control medical-insurance complex here in the US. The logical next step is for these equity-backed firms to use their capital to acquire the majority of dermatology practices in a region and be able to dictate pricing.

I'm sure that this area of medicine has been selected by equity firms because of the prevalence of cosmetic-related procedures that are inherently high-margin in this field. But there is so much money being sucked into this sector of the economy that this will encompass other types of medicine. The other area that seems to be active now is hospice care - the large insurer Anthem just bought a large palliative care provider this year. How this is not playing both sides of the trade kind of escapes me.

The whole health care sector is starting to resemble the payday loan market on a vast scale and with even less regulation. And with 2 profit-seeking players interested in shaking down the consumer in every transaction, not just one. Or, one player pretending to be two players for maximum profit.

[lotsofpulp]

Vertical integration is happening everywhere, especially due to advances in technology allowing for much greater economies of scale. Insurers have to combine with each other to get bigger to negotiate with providers and pharmacies, providers have to combine with each other to get bigger to negotiate with insurers, pharmacies have to combine with each other to negotiate with drug manufacturers and PBMs, drug manufacturers combine with each other to negotiate with insurance, and finally, insurance combines with pharmacy and PBM (Aetna/cvs) to negotiate with drug manufacturer and providers.

Telecoms, computers, retailing, everything is trending towards a handful of big players with enough vertical integration to be able to survive. Initially, this is could be good for consumers as the cost savings of economies of scale might be passed on to them, but we will pay for it at the end when there is only 2 vendors to choose from and they dictate the price.

[maxxxxx]

That's why we should discourage company growth beyond a certain size. They grow because they are better than the competition but at some point they can just overpower any competition or just buy them out.

[bmh100]

When the companies are the same type of business, it is called horizontal consolidation, not vertical integration. Vertical integration is a company buying its supplier or its customer.

[lotsofpulp]

Yes, I started off my comment referring to Anthem purchasing Aspire Health the previous commenter referred to which is vertical, but then I abruptly transitioned to talking about horizontal integration. I was trying to convey that because of the horizontal integration, the next step is to go vertical like insurance is doing with providers and PBMs and pharmacies.