Every week I add a short tidbits section to THCB Reader, our weekly newsletter summarizing the best THCB of the week (Register here!). Then I have brain waves to add them to the blog. They are short and usually not too sweet! –Matthew Holt

For today’s healthcare tidbits, there are an old chestnut I can’t seem to get away. I was triggered by three articles this week. Merril Goozner on GoozNews watched Hospital construction boom. Meanwhile, perennial favorite Sutter Health and its pricing power emerged in a report that showed, Eleven of the 19 most expensive hospital markets are located in Northern California, which dominates the market. Finally, the Gist newsletter points out that virtually all large health systems’ real profits come from their investment activities, not their operations.

None of this is a big surprise. Over the past three decades, large hospital systems have become more concentrated in their markets. They acquired smaller community hospitals and, more importantly, a feeder system for primary care physicians. At the same time, they have made deals with and acquired professional practice. Owned physicians have been loss leaders for more than two decades, with hospitals making money from their high-cost inpatient services and increasingly relying on past inpatient services that are now essentially inpatient in an outpatient setting. price provided.However, the price has not dropped – because HCCI report shows.

In these increasingly oligopolistic health systems, the total cost of healthcare now continues to increase. So so are overall premiums, self-insured employer and employee costs, and out-of-pocket costs. As a by-product, the reserves of these health systems, invested by hedge funds like hedge funds, are increasing — enabling them to buy more feeder systems.

Former Cigna publicist and now holistic health insurer critic Wendell Porter wrote this week about How much bigger and more focused health plans have become over the past decade. But the bigger story is the growth of hospital systems, and their cost and impact.Dave Chase likes to say this America’s wars cost less than hospitals do to America’s economyThis may be a bit of an exaggeration, but no one would rationally design a healthcare environment where nonprofit hospitals get bigger and richer and seem unable to inhibit any aspect of their growth.