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![]() ![]() Health System Change in Greenville, South CarolinaRound One Site VisitCase Study
The Greenville metropolitan statistical area (MSA) includes three communities: Greenville, Spartanburg and Anderson, which account for the bulk of the regions population but represent distinct health care markets. The areas population has grown steadily during the past decade, driven in part by new economic and industrial development in the Interstate 85 corridor between Greenville and Spartanburg. Nevertheless, the areas per capita income and educational attainment levels remain well below the national average. These factors, combined with South Carolinas stringent Medicaid eligibility requirements, reportedly have resulted in a large number of residents without adequate health insurance coverage. Greenville is a conservative community, and the concept of managed care conflicts with the high value many residents place on freedom of choice. The majority of the regions managed care contracts are for PPO products. Greenvilles HMO penetration is low; several HMOs have made modest inroads but none is dominant. The local health care system is dominated by several highly consolidated hospital systems. Competition between the two systems in Greenville County is acrimonious, while provider relationships in Spartanburg and Anderson have been much more collegial. In contrast to the consolidated market for hospital services, most community physicians practice independently and are not affiliated with a single hospital system. However, Greenville has one large multispecialty group practice that operates across the region and whose influence is growing. Organizational change in the provider market has been described as defensive -- "designed to keep outside health care organizations from entering the community." Nevertheless, signs of organizational change have been escalating in response to local market competition and the perceived threat of competition from outside the community. For example:
It is unclear whether these developments signal an increase in the pace of health system change. Some respondents believe that unless health care costs increase significantly, other market conditions will act to preserve the status quo and keep outside managed care organizations from making major inroads.
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