In the late 1980s, the Prospective Payment System and the expansion of managed care plans forced hospitals to be cost … efficient. The increased number of hospital mergers suggests that merging is a way to become more efficient to ensure long … scale economies among merged and control hospitals prior to the merger, and one year and two years after the merger, using …

Janeiro, which until recently relied on an expansive hospital network for health care delivery, sought in particular to expand …