Boston's top-flight teaching hospitals are among the state's greatest assets. But great assets can also bring great liabilities. Health-care costs in Massachusetts are among the highest in the nation, which burdens families, businesses and taxpayers. Some of this cost may reflect the quality of the care; more of it reflects the dynamics of the health-care business - and the clout of the Boston teaching hospitals.

Boston's top-flight teaching hospitals are among the state's greatest assets. But great assets can also bring great liabilities. Health-care costs in Massachusetts are among the highest in the nation, which burdens families, businesses and taxpayers. Some of this cost may reflect the quality of the care; more of it reflects the dynamics of the health-care business - and the clout of the Boston teaching hospitals.

As in other industries, hospitals compete for market share, combine for competitive advantage and negotiate with suppliers and customers to sweeten their bottom line. Mergers, affiliations and deal-making have changed the landscape of health care in Massachusetts over the last 20 years to a point where free-standing hospitals are a rare and endangered species.

The big dog in this pound is Partners Healthcare, which combines Mass. General, Brigham & Women's Hospital, Newton-Wellesley Hospital and a half-dozen other institutions. Partners is currently under investigation by state Attorney General Martha Coakley and a panel appointed by Gov. Deval Patrick over allegations it colluded with BlueCross BlueShield to drive up both premiums and payments to Partners.

Since its founding 15 years ago, Partners has aggressively pursued a larger market share, mostly by targeting community hospitals. It has used its reputation, its resources and its political clout to secure relationships with physicians and insurers. Now it is moving into regional hospitals' primary service areas.

Partners' latest gambit is a proposal from Newton-Wellesley Hospital to open a satellite facility on Route 30 in Framingham, featuring four operating rooms and 12 treatment rooms. The branch would surely attract patients from the two nearby hospitals operated nearby by MetroWest Medical Center. Indeed, that would seem to be its purpose.

MetroWest Medical Center officials argue the Partners clinic is not necessary, and they should be allowed to make that case. But while the state reviews the need for hospital expansion projects, that review isn't required for projects under $25 million, and the Partners proposal weighs in at $17.5 million.

That's a loophole state officials ought to fix. Study after study has demonstrated that for most illnesses, care at a community hospital is less expensive than at a teaching hospital, and every bit as good. But community hospitals are struggling to stay afloat, while behemoths like Partners get ever more wealthy.

Competition is supposed to drive prices down, but in health care, it seems to drive costs higher. Proposals like Partners' Framingham branch office will only make things worse. It's time the state stepped in, with a more effective determination-of-need process.

The MetroWest Daily News