Federal Trade Commission Summary

The Iron triangle for healthcare consists of cost, quality, and access; these three characteristics when balanced create great healthcare. Managed Care Organizations combine the three to offer consumers with care that is appropriate for their individual needs. Our book describes managed care organizations as “the cost management of healthcare services by controlling who the consumer sees and how much the service cost” (Basics of the U.S Healthcare System, Niles). Taking a look at the history prior to the Health Maintenance Organization Act of 1973 (HMO ACT of 1973) the implementation has been significant in balancing cost, and quality control. Before this Act was signed in to law by President Nixon healthcare costs were determined by fee for service. A fee for service or indemnity plan is a plan that allows the provider to determine the cost of service, this fee for service plan caused for healthcare costs to increase rapidly. An example of this would be going to the doctor with neck pain, being told to stretch then receiving a bill for 25,000 dollars. As could be understood the cost of healthcare had became a problem.

The PHO served as a vehicle through which competing hospitals and physicians could bargain collectively with health plans to obtain higher fees for themselves. The owner PHOs, member hospitals, and member physicians canceled contracts with payors and informed them that the PHO would be the sole entity through which they would enter into payor contracts. To contract with the PHO, payors allegedly have had to accept the fixed physician fee schedule and fixed discount of no more than 10 percent off hospital list prices.

The Federal Trade Commission(FTC) was created in 1914. It was created to ensure that there were no businesses that were anticompetitive; meaning that there wasn’t one company or business that was creating a monopoly. The FTC has three main goals; they are to protect consumers, maintain competition, and advance performance. They protect the consumers by preventing fraud and making sure businesses are fair in the marketplace. They maintain competition by preventing companies from merging together and creating a monopoly. Finally, they advance performance by advancing the FTC’s performance through organizational, personal, and management excellence. The FTC is very beneficial, and although not everybody knows about it, as a consumer it helps with the economy of every American. Throughout the years since it was created, there has been more laws added that help keep businesses

It also declares an “unfair method for the sake of competition that affects commerce, and also being involved in the deceptive acts which affect commerce, are declared unlawful.” The Don’s restaurant is rather famous and has great market value. This means that there must be competitors in the market for Don’s restaurant to participate in various acts. The truth will be known once the investigations have been made. Injustice and deception for the consumers symbolizes two separate areas of the FTC authority and enforcement. The FTC has the authority to overtake all the unfair techniques of the competition between the businesses (Macaulay, 1979).

The paper will serve as a historical background overview of how the Federal Trade Commission Act (FTC) came into existence. The paper will also break down the key components for which the FTC covers, such as deceptive advertising, baiting and switching and consumer fraud. There will be examples

1. If doctors and hospitals cooperate to provide better care and lower cost, not to force higher fees from payers, so that the PHO can offer a convincing plan to payers.

The Federal Trade Commission enforces a variety of federal antitrust and consumer protection laws. The Commission seeks to

According to the Federal Bureau of Investigation (FBI) “health care fraud costs the country an estimated $80 billion dollars a year” ("Health Care Fraud," n.d., p. 1). Because health care costs continue to rise more rapidly than the rate of inflation the threat of health care fraud continues to rise. The Affordable Health Care Act has put new policies in place to identify and stop health care fraud. The FBI along with other government, insurance, and public agencies have joined together to combat fraud at every level. New rules in identifying, investigating, and prosecuting fraud before payments are made to medical providers could save billions of

Making horizontal unofficial agreements with other competing physicians by acting through respondent to fix prices for treatment process which is usually high.

In an attempt to understand the impact of managed care in the U.S, I look at the most commonly expressed complaints against the organization. In a survey of consumers, 60% said that managed care had not made a difference in health care cost or had actually been the cause of the increase of health care cost. Managed care has had an impact on slowing the rates of growth in the costs of two major health care producers: hospitals and physicians. Little evidence has suggested that the current reimbursement are inadequate to the care provided. The quality of care is a highly debated issue. Physicians are concerned that the quality of care in managed care organizations may reflect the loss of professional autonomy through pre-authorization procedures.

In the late 1960’s, the FTC was a paper tiger. Ralph Nader, who began the consumer protection movement in this country with the publication of Unsafe At Any Speed, was a sharp critic of the Federal Trade Commission for its lack of consumer protection. Specifically, the FTC was criticized because it relied too heavily on consumer complaints and brought enforcement actions only on a case-by-case basis. The consumer protection movement wanted the FTC to proceed against entire industries rather than individual businesses.

The external stakeholders are the community, patients, MedKey System members, CMS, HMOs (ie. Blue Cross Blue Shield and Tri-Care), and any other private insurances (Richards & Slovensky, 2004). Medicare reimbursement in Alabama was the lowest rate in the nation. This was a constant struggle for the hospital administrators to try to operate on such low reimbursements for their services, which is a threat. Eighty percent of patients were Medicare or Blue Cross in which there was difficulty-negotiating prices with Blue Cross due to monopoly. Buyers have high bargaining power as reimbursements rates are low from Medicare and Blue Cross held monopoly in the services area so negotiating prices was difficult. Suppliers have lower bargaining power due to low Medicare reimbursements and difficulty negotiating prices with Blue

HMOs multiplied rapidly with the new federal giveaways. Managed care, now including PPOs, mushroomed. Employers initially perceived managed care plans as cheaper than traditional fee-for-service insurance. Gradually, they stopped offering a choice of health plans, making individual policies more expensive. HMOs' penetration of the industry had been subsidized into existence. Government had instituted managed care. Today, while overall quality of patient care remains the best in the world, doctors practice medicine in an increasingly intricate web of rationing and regulations: Physicians are stripped of professional autonomy. As patients wander the maze of managed bureaucracy, costs rise and quality deteriorates. Every American dependent on a third party for health coverage is a potential victim of managed care. And state sponsored management of medicine

Besides, studies delving into the economics of the medical marketplace consistently find that a moderately higher or lower price doesn't change consumer purchasing decisions much, if at all, because in health care there is little of the price sensitivity found in conventional marketplaces, even on the rare occasion that patients know the cost in advance. Most hospital administrators defend such chargemaster rates at all, they maintain that they are just starting points for a negotiation. But patients don't typically know they are in a negotiation when they enter the hospital, nor do hospitals let them know that.

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).