Antitrust In Healthcare

The competitor would provide similar services that could potentially hinder PHC’s progress toward accomplishing its service and profitability goals.

Melnick, G., & Fonkycj, K. (2013). Fair pricing law prompts most California hospitals to adopt policies to protect uninsured patients from high charges. Health Affairs, 32(6), 1101-1108. Retrieved from http://ezproxy.nu.edu/login?url=http://search.proquest.com/docview/1372932073?accountid=2532

High concentration in the market, as we all know, leads to market inefficiency, where insurers are able to set inadequate or unfairly discriminatory premium rates. Few oligopoly firms operating in the statewide markets are definitely to use market power for their advantages. These can be tightening barriers to entry what some of the US health insurers have been doing. For instance, large insurance companies like UnitedHealth Group, WellPoint and Aetna have been acquiring existing smaller health insurers without developing their own networks and products. These acquisitions tend to decrease competition and thus making insurance market more concentrated. On the other hand, there are more of the few ways of getting rid of competitors, one of them being through cost-efficiency. As far as Choi and Weiss (2005) concerned, cost-efficient firms are able to minimize cost and thus charge lower prices than competitors, which

Over the years, the insurance companies have searched for ways to increase their profit margins at the expense of the hard working Americas striving to maintain their health at an affordable cost. The exchange appears to be working under the guise that they are trying to improve the quality of the health care delivered to patients. However, this does not seem genuine when closely examined. Inspection of performance of hospitals and providers is normal for certifying bodies such as the Joint Commissions and The Centers for Medicare & Medicaid Services (CMS), not insurance companies. Fraudulent claims normally investigated by insurance companies are normally caught and the company recovers some of that cost or denies the claim altogether if fraud is suspected. With this, it appears that the exchange is trying to branch off into a section of health care that it has not normally concerned itself with over the time that insurance companies have existed. It could be argued that the exchange may be

The Affordable Care Act was created to assure all Americans have access to affordable insurance, but as stated by Sir Isaac Newton for every action there’s an equal and opposite reaction. As more and more people become insured in this country, the for-profit insurance companies are reaping the benefits from the legislation of the Affordable Care Act.

Last February, the Supreme Court issued its opinion in North Carolina State Board of Dental Examiners v. Federal Trade Commission (Dental Examiners). The case concerned the Board’s decision to stop teeth whitening services by non-dentists in the state. The Federal Trade Commission alleged that the Board had violated antitrust laws by attempting to limit competition by its teeth whitening decision. State entities such as the Board generally were thought to have immunity from antitrust laws, but the Supreme Court’s decision reversed this long-held belief and found that state boards could be held liability if certain conditions were met. The major condition was that the board be made up of a majority of active market

The Federal Trade Commission actively enforces antitrust laws to organizations within the healthcare field, including to Physician Hospital Organizations (PHOs). A PHO is a vehicle that enables hospitals and physicians to work cooperatively toward accomplishing several objectives (Physician, 2015). According to Susan Creighton (2004), competitive issues among PHOs can occur when a PHO acts as a contracting arrangement for a network of healthcare providers. The network can consist of groups of physicians, one hospital or several, and also some other entities that offer a bundle of healthcare services to insurance companies and other payors (Creighton, 2004). The FTC states that the core antitrust law principle is that it is illegal for competitors to agree on prices they will charge, except where they come together and integrate in a legitimate joint venture that results in efficiencies or other precompetitive benefits that outweigh the restriction of competition (Creighton, 2004). Agreements that violate the antitrust law can be determined as per se illegal. Per se illegal means that activities, such as horizontal price fixing, or group boycotts, have been conclusively presumed to restrain competition unreasonably even without a study of the market that they occurred in, or an analysis of their actual effect on competition, or their purpose (Burke, et al., 2009). South Georgia Health Partners are an example of a PHO that was charged by the commission on a per se illegal

The variances between criminal law and antitrust are criminal law constitutes an offense that is committed by a citizen, and the level of punishment will vary based on the crime. Antitrust on the other hand is a law that controls the actions of a business entity to ensure that the consumers are receiving fair treatment. Both of these statutes have the ability to be tried either at the state or federal level. These laws have an enormous impact on health care in the 21st century as it demonstrates that the government not tolerate misconduct and these laws are in effect to protect the interest of the public. U.S. health care administrators have a duty to oversee the staff and the operation of the facility and is accountable for taking appropriate actions to report any wrongdoing. Administrators are at the forefront of the organization and must monitor the staff and the

Regulations that prevent insurance companies from participating in interstate commerce have caused competition to grow stagnant in the United States. This lack of competition has allowed the adoption of wasteful procedures by healthcare providers, which in turn passes the increased expenses back to the insurance companies. Therein, insurance costs increase, crippling consumer’s cash flow and quality of life. While healthcare costs continue to rise, people must scrutinize the current healthcare system.

On the local level, in Illinois, the FTC filed an administrative complaint against a merger between Rockford Health System and Sisters of the Third Order of St. Francis (OSF) Healthcare System. The FTC argued that the merger “would lead to significantly higher costs that would be passed on to employers and to health care consumers in Rockford” and would harm local employers and patients (FTC.gov, 2011). The FTC further alleges that competition would be reduced and local business would be impacted by higher insurance rates and patients would see hikes in co-pays, insurance premiums and “other out of pocket expenses” (FTC.gov, 2011). Moreover, in violation of the Clayton Antitrust Act, the merger would have reduced acute-care inpatient services, and primary care physician services from three provider systems to two creating a monopoly and

The purpose of this paper is to discuss how true clinical integration of hospitals and physicians is impacted by The Federal Trade Commission policy statements. In this context, the term true clinical integration is used to describe engagement and alignment among hospitals and physicians to achieve meaningful clinical process redesign that can change culture and lead to lasting differences in the way care is delivered. This is to differentiate the term clinical integration as an alignment vehicle principally for antitrust liability avoidance purposes.

Health and Human Services (HHS) should work with the Federal Trade Commission (FTC) to identify healthcare monopolies in small to

Another group often blocked is complementary or alternative health care practitioners. These restrictions and the insurance industry unwillingness to pay for these services, gives the physicians an almost monopolist control over health care. Providers must be able to enter the market for competition to work and there must be many providers vying for the patient. To get the most out of health insurance plans Consolidation of hospitals and multispecialty group practices increases the negotiating leverage of the group but in certain areas of the US a single large medical system has become the sole provider of major health service thereby restricting competition (Shi & Singh, 2008). This consolidation while giving the hospitals and group practice leverage when negotiating prices of supplies and services tends to increase the price of health care to the patient because there is no longer any competition (Shi & Singh, 2008). For these reason “competition will remain less effective in most health care markets, because the prerequisite for fully competitive markets are not fully met” (Federal Trade, 2004, p. 20).

There are many different forms of competition among health care organizations. Some of them are the prices of services, different co-pays someone will have to pay out of pocket, lower premiums, they have to be competitive in the quality of the service in which they perform daily. The health care competition is being advertised every day. The competitive nature of business cause them to reach out to the community. The health care industry has to fight for the approval of the community, the government, the insurance companies, the pharmaceutical companies and of course the stake holders as well as future investors.

In all industries, competition among businesses has long been encouraged as a mechanism to increase value for patients. In other words, competition ensures the provision of better products and services to satisfy the needs of customers (Glover & Rivers, 2009). In the health care industry, competition has an impact on many relational perspectives. There have been several studies examining the relationships between competition and quality of health care, competition and health care system costs, and competition and patient satisfaction. Some elements of competition in health care are price, quality, convenience, and superior products and