Ballad Health: Understanding Appalachia’s Regional Healthcare Monopoly

The Ballad Health merger of 2018, which combined the now 21 hospitals in the region under one organization, has impacted the healthcare landscape in Northeast Tennessee and Southwest Virginia. Historically, Appalachia has had to persevere through primary physician shortages, a lack of specialty care, geographic obstacles to accessing healthcare, challenges related to substance abuse, and much more. Since the merger of Mountain States Health Alliance and Wellmont Health System, little research has been done to assess the perceived impact the aggregation of providers has had on the population it serves. This study utilizes an online survey to better understand the perceived changes in quality and delivery of healthcare provided by Ballad Health in the Tennessee counties of Greene, Washington, Sullivan, Unicoi, Hawkins, Carter, Hancock, and Johnson. After survey data was collected, researchers analyzed participant responses to try to quantify the impact on quality and delivery of healthcare services after the Ballad Merger. The 683 completed surveys showed an almost 2 point difference in overall quality between the two time periods, and a negative trend for every dependent variable that seeks to measure delivery. The data not only shows dissatisfaction with the quality and delivery of services offered by Ballad Health, but a clear negative impact on individuals' perception of healthcare in general.