Health system mergers were sold as a path to better, more efficient care. The data tells a different story, and our members are paying for it.

As North Carolina’s only not-for-profit health insurer, our responsibility is to our members and communities, not shareholders. That’s why we speak up about the drivers of rising costs and push for changes that put affordability first for North Carolinians.

In recent years, hospital ownership in North Carolina has shifted significantly toward fewer, larger health systems. More than 70 percent now operate in markets dominated by a single system or a small handful of them. Each of those transactions was framed, in one way or another, as good for patients, with promises of more coordinated care, efficient operations, and investment in the community.

After more than a decade of evidence, those promises have not held up.

The research shows hospital mergers raise prices up to 65 percent in national studies, even when the hospitals involved are nonprofit. A Harvard analysis found that, inside consolidated systems, physician services cost up to 26 percent more and hospital services cost 31 percent more, on average, than they would otherwise. Those increases go through employers, to premiums, to deductibles, and ultimately to families trying to make a medical bill fit alongside everything else.

Cost is only half the story: The other half is how consolidation impacts access. A 2026 Health Affairs Scholar study found that patients wait about 15 days longer for appointments at hospital or system-affiliated primary care practices than at independent ones. As health systems expand, those delays grow, further limiting access to timely care. In some communities, that impact is already visible, with patients waiting months for a primary care appointment.

The standard rebuttal is that growth buys quality, allowing larger health systems to invest in better technology and specialized care. But the evidence does not support that claim. U.S. Department of Health and Human Services research shows (PDF) that hospital-physician consolidation generally does not improve quality of care, and that in markets where competition disappears, outcomes can get worse. 

The historical patterns for these consolidations continue to increase prices and make access harder, while quality goes unchanged or worse. It is not the deal North Carolinians were promised, and it is not a deal we should keep accepting. 

This isn’t about criticizing hospitals for trying to survive. It’s about recognizing a system that too often leaves consolidation as the only viable path. 

Now is the time to come together and work toward the changes needed so hospitals can remain independent and able to access the capital, technology, and support they need, without pushing health care costs even higher.

We’re committed to collaborating on practical changes to address the structural challenges driving higher costs across North Carolina’s health care system. North Carolinians deserve a health care system that prioritizes their health, not market dominance. We must work together, with greater openness and transparency, on bigger solutions.