With so much focus on the March 31 deadline for signing up for health insurance under the Affordable Care Act, it has been easy to overlook some of the other seismic shifts in Connecticut’s health care landscape that have the potential to affect how people access medical services in the future. Having insurance is important. So is having a health care delivery system that preserves the primacy of the physician/patient relationship over profits.

Two recent trends affecting the economic underpinnings of the state’s hospitals will, according to hospital officials, help physicians meet the increasingly expensive challenge of providing first-rate medical care while preserving a viable business model for hospitals facing a significant loss of state funding and ever-increasing expenses. One is the consolidation of medical services, as hospitals buy up the practices of independent physicians. The other is a bid by some traditionally nonprofit hospitals in the state to forge partnerships with out-of-state for-profit companies that will provide them with capital to upgrade facilities and equipment.

These moves may be great for the economic health of hospitals and their prospective shareholders; the health benefit for the people of Connecticut is less certain. Just as many people are transitioning to health insurance plans with higher deductibles, the advent of hospital-affiliated physician practices is generating a new layer of “facility fees.” Whereas a patient may have previously paid one bill for an in-office procedure, now two bills are presented: one from the doctor and one from the hospital for extravagantly expensive “outpatient services,” often not covered by insurance. The result can be thousands of dollars in unexpected costs for patients. Unfortunately, it is almost impossible for consumers to know the price of health services at the point when they must purchase them. The system also robs the health marketplace of competition and small independent medical practices where doctors are freer to exercise their prerogatives as physicians first.

Converting Connecticut’s nonprofit hospitals to for-profit health care centers will require the cooperation of the legislature. Current law makes it difficult for for-profits to hire physicians. Keeping the state’s hospitals viable should be a priority for lawmakers — in addition to the services they provide, many hospitals are among leading employers in their communities. But for-profit health care is just that: for profit. When the interests of patients go up against the interests of investors, the outcome is predictable.

We urge the legislature to come down on the side of the people of Connecticut on these matters. Our health care system should be, first and foremost, about the physician/patient relationship. A good starting place would be to require greater transparency for health care consumers, including prior notification of fees. It will restore accountability and trust to that relationship. In the end, a system based on inscrutability benefits neither the patient nor the investor.