{
  "abstract": "Objectives Concerns over how large for-profit corporations may affect healthcare access, quality and costs are growing. The pursuit of financial profits are a key driver in the overutilisation of health services that provide negligible benefits and may result in patient harm. Further, high levels of market concentration raise concerns about the potential for these large firms to exert political influence and impact health policy. The aim of this study was to determine who owns Australian diagnostic imaging clinics and identify areas of market consolidation.Method Australian diagnostic imaging practices that provide x-ray, ultrasound, and at least one advanced imaging modality (CT and/or MRI) services were included. Data from the Australian Business Register, the ORBIS database and clinic website were obtained and cross-referenced to identify the ultimate owners of each clinic. Ownership entities were categorised as either government, not-for-profit, public limited (e.g., owned by shareholders), institutional investor-backed private (e.g., private equity), independent private (e.g., radiologist-owned clinics), or trust. The main outcome measure was the proportion of diagnostic imaging clinics by ownership category. Subgroup analyses by jurisdiction (state/territories), geographical remoteness, and provision of MRI services were performed using a Pearson’s Chi-square test. Areas of high market consolidation were defined as one company owning ≥30% of non-government owned clinics within a jurisdiction.Results Ownership data was obtained for 1226 of the 1235 (99.3%) diagnostic imaging clinics that met our inclusion criteria. Most clinics were owned by large for-profit corporations; 412 (33.6%) clinics were owned by public limited companies and 277 (22.6%) clinics by institutional investor-backed companies. Levels of large for-profit corporation ownership varied geographically, with clinics owned by large for-profit corporations more prevalent in the less populous states (Tasmania, Australian Capital Territory), in metropolitan areas and more likely to provide MRI. Significant market consolidation was observed in less populous states like Tasmania, South Australia, and the Australian Capital Territory, where one company often owned a substantial share of clinics. Additionally, higher levels of corporatisation were associated with clinics offering MRI services, with four companies controlling over 50% of these services nationally.Conclusions Our analysis reveals that more than half of Australia’s diagnostic imaging clinics are now owned by large for-profit corporations, with considerable market consolidation in certain states and territories. This trend is especially pronounced among clinics that provide MRI services, which traditionally generate higher profit margins. The impact of these findings on healthcare access, affordability and quality of care remains unexplored. We plan to use this foundational work to ascertain whether corporatisation and market consolidation influence the overuse of diagnostic imaging services. Understanding the systems, practices and pathways through which commercial actors drive overtesting is necessary to develop effective solutions.",
  "authors": [
    {
      "affiliations": [
        "Monash University, Melbourne, Australia"
      ],
      "name": "Sean Docking"
    },
    {
      "affiliations": [
        "University of Melbourne, Melbourne, Australia"
      ],
      "name": "Jenn Lacy-Nichols"
    },
    {
      "affiliations": [
        "University of Tasmania, Hobart, Australia"
      ],
      "name": "Martin Hensher"
    },
    {
      "affiliations": [
        "Monash University, Melbourne, Australia"
      ],
      "name": "Rachelle Buchbinder"
    }
  ],
  "title": "034 Understanding the commercial determinants of overservicing: corporate ownership of Australian diagnostic imaging practice",
  "uid": "5a0b4b61-193f-57f2-995d-d8a0ff726dda"
}