Is Bigger Better? The Implications of Health Care Provider Consolidation

An Interview With Atul Gawande
Doctors go over a patient's charts in the emergency room.

Urban Institute’s Robert Berenson interviews surgeon and The New Yorker columnist Atul Gawande to explore the potential benefits and drawbacks of “Big Medicine”—standardized, evidence-based health care delivered by large health care chains.

The Issue

To sort through the potential benefits and drawbacks of Big Medicine, Atul Gawande and Robert Berenson, a former practicing internist, vice chair of MedPAC, and a current institute fellow at the Urban Institute, came together for a discussion. In this interview, Gawande talks about what different versions of Big Medicine could look like and addresses whether an organization needs to be big to adopt the positive aspects of Big Medicine.

In his 2012 New Yorker article “Big Med,” Gawande made a case for bringing restaurant-chain efficiency to the health care sector noting that big chains thrive because:

Key Findings

  • They provide goods and services of greater variety, better quality, and lower cost than would otherwise be available.

  • Size gives them buying power, lets them centralize common functions, and allows them to adopt and diffuse innovations faster.

About the grantee

The Urban Institute is a nonprofit, nonpartisan policy research and educational organization that examines the social, economic, and governance problems facing the nation. For more information, visit www.urban.org. Follow the Urban Institute on Twitter www.urban.org/twitter or Facebook www.urban.org/facebook.

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