Biomaterial Database

Can provider antitrust suits against payers be successful? 1986

R J Enders

In today's increasingly competitive healthcare marketplace, payers, not providers, are the driving force in the healthcare delivery system. Therefore, providers are feeling greater pressure to compete on price and other terms to become recommended providers for these payers. The question becomes: what, if any, antitrust claims does a provider have who is excluded from a payer's healthcare program, receives a lower rate of payment compared to other providers in a payer's program, or is disadvantaged by a payer's pricing decision?

UI	MeSH Term	Description	Entries
D007348	Insurance, Health	Insurance providing coverage of medical, surgical, or hospital care in general or for which there is no specific heading.	Group Health Insurance,Health Insurance,Health Insurance, Voluntary,Health Insurance, Group,Health Insurances,Insurance, Group Health,Insurance, Voluntary Health,Insurances, Health,Voluntary Health Insurance
D010820	Physicians	Individuals licensed to practice medicine.	Physician
D011243	Preferred Provider Organizations	Arrangements negotiated between a third-party payer (often a self-insured company or union trust fund) and a group of health-care providers (hospitals and physicians) who furnish services at lower than usual fees, and, in return, receive prompt payment and an expectation of an increased volume of patients.	Organizations, Preferred Provider,Preferred Provider Organization,Organization, Preferred Provider
D011682	Purchasing, Hospital	Hospital department responsible for the purchasing of supplies and equipment.	Hospital Purchasing,Hospital Purchasings,Purchasings, Hospital
D004465	Economic Competition	The effort of two or more parties to secure the business of a third party by offering, usually under fair or equitable rules of business practice, the most favorable terms.	Competition, Economic,Competitions, Economic,Economic Competitions
D004467	Economics	The science of utilization, distribution, and consumption of services and materials.	Consumer Price Index,Capital,Conditions, Economic,Consumption,Cost of Living,Easterlin Hypothesis,Economic Conditions,Economic Policies,Economic Policy,Economics, Home,Home Economics,Household Consumption,Macroeconomic Factors,Microeconomic Factors,Policies, Economic,Policy, Economic,Production,Remittances,Utility Theory,Condition, Economic,Consumer Price Indices,Consumption, Household,Economic Condition,Factor, Macroeconomic,Factor, Microeconomic,Factors, Macroeconomic,Factors, Microeconomic,Household Consumptions,Hypothesis, Easterlin,Index, Consumer Price,Indices, Consumer Price,Living Cost,Living Costs,Remittance,Theories, Utility,Theory, Utility,Utility Theories
D006279	Health Maintenance Organizations	Organized systems for providing comprehensive prepaid health care that have five basic attributes: (1) provide care in a defined geographic area; (2) provide or ensure delivery of an agreed-upon set of basic and supplemental health maintenance and treatment services; (3) provide care to a voluntarily enrolled group of persons; (4) require their enrollees to use the services of designated providers; and (5) receive reimbursement through a predetermined, fixed, periodic prepayment made by the enrollee without regard to the degree of services provided. (From Facts on File Dictionary of Health Care Management, 1988)	Group Health Organizations, Prepaid,HMO,Prepaid Group Health Organizations,Health Maintenance Organization,Organizations, Health Maintenance,Organization, Health Maintenance
D006761	Hospitals	Institutions with an organized medical staff which provide medical care to patients.	Hospital
D014481	United States	A country in NORTH AMERICA between CANADA and MEXICO.
D014485	United States Federal Trade Commission	An independent administrative agency concerned with maintaining competitive free enterprise by prohibiting unfair methods of competition and unfair deceptive acts or practices.	Federal Trade Commission (U.S.),USFTC,Federal Trade Commission