Why Consolidation—not Utilization—is Driving Healthcare Prices

Another week, another headline reinforcing why hospital consolidation, not utilization, is the primary driver of rising healthcare costs.

HCA Healthcare is once again signaling aggressive outpatient acquisition as a growth strategy. This is being framed as “efficiency” and “scale”. In reality, it's something far more damaging: anti-competitive market dominance that predictably leads to higher prices.

Let’s be clear...A system does not need 70–80% market share to achieve monopoly-like pricing power. In many regional markets, far less concentration is required to control rates, suppress competition, and dictate terms to employers and patients alike.

We’ve already seen how this plays out…

HCA makes an acquisition then proceeds to dramatically increase prices for the same services simply because competition has been removed. The quality of care didn’t suddenly increase. The prices did. And employers feel it immediately.

And it’s worth grounding this discussion in the financial reality.....HCA reported $6.8 billion in net income in 2025, a 17.8% increase year over year, and is projecting $6.5–$7 billion in net income for 2026. At the same time, per Becker’s Hospital Review, Sam Hazen, HCA’s CEO, earned $23.8 million in total compensation in 2024—a figure that can reasonably be assumed has grown since then, given the company’s performance. This is not a system under financial strain; it is a system extracting value through market dominance, while employers and patients absorb the cost.

This is why employers consistently cite hospital costs—not drugs, not overutilization—as their number one concern. Outpatient expansion through acquisition doesn’t lower costs when the acquirer’s strategy is to dominate a market and raise prices once alternatives disappear.

There is nothing “value-based” about consolidation that eliminates competition.

There is nothing sustainable about a system that rewards scale over accountability.

And there is nothing more damaging to pricing than allowing a handful of systems to control access, sites of care, and reimbursement in regional markets.

If we are serious about lowering healthcare costs, we have to stop pretending consolidation is the solution—and start confronting it as the problem. More to come…

The Full Story in Becker’s Healthcare: https://www.beckershospitalreview.com/capital/hca-ramps-up-outpatient-growth-sees-more-acquisition-opportunities/