Biomaterial Database

Antitrust, competition, and health care reform. 1994

R E Bloch, and D M Falk

The goals of health care reform and the antitrust laws are similar: promotion of consumer welfare. Under reform, having large groups of consumers and providers will offer substantial efficiencies in purchasing and providing health care services but also will pose some antitrust risks. Health alliances may have excessive market power. Health plans and provider networks may have the potential to foreclose competition from actual or potential rivals. Mergers and joint ventures between providers will proliferate but may raise similar problems. Explicit exemptions from the antitrust laws-through federal or state legislation-may significantly limit the benefits of competition for consumers. A reformed health care system will not reduce the need for antitrust enforcement.

UI	MeSH Term	Description	Entries
D008329	Managed Care Programs	Health insurance plans intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as HEALTH MAINTENANCE ORGANIZATIONS and PREFERRED PROVIDER ORGANIZATIONS.	Case Management, Insurance,Insurance Case Management,Managed Health Care Insurance Plans,Managed Care,Care, Managed,Managed Care Program,Management, Insurance Case,Program, Managed Care,Programs, Managed Care
D009310	National Health Insurance, United States	Federal system administering national health insurance in the United States.	Federal Health Insurance Plans, United States,United States National Health Insurance
D003164	Competitive Bidding	Pricing statements presented by more than one party for the purpose of securing a contract.	Contract Bidding,Request for Proposal,Bidding, Competitive,Bidding, Contract,Biddings, Competitive,Biddings, Contract,Competitive Biddings,Contract Biddings,Proposal, Request for,Proposals, Request for,Request for Proposals
D003363	Cost Control	The containment, regulation, or restraint of costs. Costs are said to be contained when the value of resources committed to an activity is not considered excessive. This determination is frequently subjective and dependent upon the specific geographic area of the activity being measured. (From Dictionary of Health Services Management, 2d ed)	Cost Containment,Containment, Cost,Containments, Cost,Control, Cost,Controls, Cost,Cost Containments,Cost Controls
D006265	Health Care Coalitions	Voluntary groups of people representing diverse interests in the community such as hospitals, businesses, physicians, and insurers, with the principal objective to improve health care cost effectiveness.	Business Coalitions (Health Care),Business Coalitions (Healthcare),Healthcare Coalitions,Business Coalition (Health Care),Business Coalition (Healthcare),Coalition, Business (Health Care),Coalition, Business (Healthcare),Coalition, Health Care,Coalition, Healthcare,Coalitions, Business (Health Care),Coalitions, Business (Healthcare),Coalitions, Health Care,Coalitions, Healthcare,Health Care Coalition,Healthcare Coalition
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014481	United States	A country in NORTH AMERICA between CANADA and MEXICO.
D015271	Insurance Pools	An organization of insurers or reinsurers through which particular types of risk are shared or pooled. The risk of high loss by a particular insurance company is transferred to the group as a whole (the insurance pool) with premiums, losses, and expenses shared in agreed amounts.	Health Alliances,Alliance, Health,Alliances, Health,Health Alliance,Insurance Pool,Pool, Insurance,Pools, Insurance
D016363	Antitrust Laws	Those federal and state laws, and their enforcement, that protect trade and commerce from unlawful restraints and monopolies or unfair business practices.	Antitrust Liability,Sherman Antitrust Act,Act, Sherman Antitrust,Antitrust Act, Sherman,Antitrust Law,Antitrust Liabilities,Law, Antitrust,Laws, Antitrust,Liabilities, Antitrust,Liability, Antitrust
D016536	Competitive Medical Plans	Alternative health care delivery mechanisms, such as PREFERRED PROVIDER ORGANIZATIONS or other health insurance services or prepaid plans (other than HEALTH MAINTENANCE ORGANIZATIONS), that meet Medicare qualifications for a risk-sharing contract. (From Facts on File Dictionary of Health Care Management, 1988)	Competitive Health Plan,Competitive Medical Plan,Medical Plan, Competitive,Medical Plans, Competitive,Competitive Health Plans,Health Plan, Competitive,Health Plans, Competitive,Plan, Competitive Health,Plan, Competitive Medical,Plans, Competitive Health,Plans, Competitive Medical