Hospitals merge to constrain costs and improve quality. Although hospital consolidation can yield substantial cost and qualitative efficiencies, it can also harm competition by creating market power. Can the agencies and the courts strike the appropriate balance between the quality improvements a hospital merger brings and the risk of market power? Can they assess the quality improvements stemming from the hospital merger and weigh them against potential anticompetitive harm? And, if yes, how? These questions are not easy. However, this essay raises and examines them. Exploring the seminal US hospital merger cases, it underlines that the agencies, driven by the belief that healthcare is not special, focus more on the mergers' impact on prices and less on quality. It concludes that the agencies, by narrowing their analysis to the price concerns of a hospital merger, disincentivize merging parties from bringing quality of care arguments at the heart of the merger analysis and health policy researchers from developing research examining hospital mergers' impact on quality. It suggests that the Federal Trade Commission (FTC) should issue guidelines explaining what quality dimensions it values most on the basis of the main objectives of the US healthcare system and how these dimensions can be balanced against harm to competition.

Healthcare markets have started being created in Europe. Indeed, some European countries, such as the UK and the Netherlands, have started adopting the choice and competition model for healthcare delivery. Taking as a starting point that as health systems in Europe move towards market driven healthcare delivery, the application of competition law in these systems will increase, the goal of this doctoral thesis is (a) to identify some of the competition problems that may be raised in light of the reality that especially in hospital and medical markets the pursuit of competition and the pursuit of essential dimensions of healthcare quality may inevitably clash (b) to demonstrate that competition authorities would be unable to address some of these competition problems if they did not pose and address a fundamental question first: how should we define and assess quality in healthcare? How should we take healthcare quality into account in the context of a competition analysis? In delving into these questions, this doctoral thesis explores how the notion of healthcare quality is defined from antitrust, health policy and medicine perspectives and identifies three different models under which competition authorities may actually assess how a specific anticompetitive agreement or hospital merger may impact on healthcare quality. These are: (a) the US market approach under which competition authorities may define quality in healthcare strictly as choice, variety, competition and innovation (b) the European approach under which competition authorities may extend the notion of consumer welfare in healthcare so that it encompasses not only the notions of efficiency, choice and innovation, but also the wider objectives and values European health systems in fact pursue (c) the UK model under which competition authorities may cooperate with health authorities when they assess the impact of a specific transaction on healthcare quality. The thesis identifies the main merits and shortcomings of these models and emphasizes that what is crucial for the adoption of a holistic approach to healthcare quality is not only the model under which healthcare quality is actually integrated into a competition analysis but also competition authorities’ commitment to protect all dimensions of this notion. --

Market driven healthcare is massively divisive. Opponents argue that a competition approach to medical treatment negatively impacts on quality, while advocates point to increased efficiencies. This book casts a critical eye over both positions to show that the concerns over quality are in fact real. Taking a two part approach, it unveils the fault lines along which healthcare provision and the pursuit of quality would in certain cases clash. It then shows how competition authorities can only effectively assess competition concerns when they ask the fundamental question of how the concept of healthcare quality should be defined and factored into their decisions. Drawing on UK, US and EU examples, it explores antitrust and merger cases in hospital, medical and health insurance markets to give an accurate depiction of the reality and challenges of regulating competition in healthcare provision.

The health care industry continues to undergo unprecedented consolidation. Health care providers and payors alike have pursued a wide variety of integrative strategies to achieve efficiencies or other business advantages. The Health Care Mergers and Acquisitions Handbook is designed to educate the practitioner about the antitrust analysis of mergers and acquisitions within the health care industry. Over the past two decades there has been an extraordinary amount of litigation related to challenges of hospital mergers. Each chapter identifies and analyzes important antitrust issues governing such consolidations. Accordingly, the first several chapters are devoted to a detailed treatment of substantive issues peculiar to such mergers: an introduction to hospital merger litigation, describing trends in litigation and the way in which such mergers are analyzed; issues unique to market definition, including product market definition and geographic market definition; the competitive effects of hospital mergers, assessing the evidence necessary to establish a prima facie case in a merger challenge and the rebuttal arguments offered by merging parties; a unique rebuttal argument offered by merging hospitals that is treated separately due to its prominent role in hospital merger litigation - the role and significance of efficiencies in determining the competitive merits of such mergers; the potential applicability of the state action doctrine to hospital mergers. In addition to a substantive treatment of hospital mergers, the Handbook also addresses; combinations of health care management organizations (HMOs) and physician practice groups; the analysis used by the enforcement agencies when reviewing mergers of HMOs; antitrust issues posed by physician practice consolidations. The appendix contains a chart summarizing litigated hospital mergers.--

"[This book is] the most authoritative assessment of the advantages and disadvantages of recent trends toward the commercialization of health care," says Robert Pear of The New York Times. This major study by the Institute of Medicine examines virtually all aspects of for-profit health care in the United States, including the quality and availability of health care, the cost of medical care, access to financial capital, implications for education and research, and the fiduciary role of the physician. In addition to the report, the book contains 15 papers by experts in the field of for-profit health care covering a broad range of topicsâ€"from trends in the growth of major investor-owned hospital companies to the ethical issues in for-profit health care. "The report makes a lasting contribution to the health policy literature." â€"Journal of Health Politics, Policy and Law.

Provides a diverse, multi-faceted approach to health care evaluation and management The U.S. Health Care System: Origins, Organization and Opportunities provides a comprehensive introduction and resource for understanding healthcare management in the United States. It brings together the many "moving parts" of this large and varied system to provide both a bird's-eye view as well as relevant details of the complex mechanisms at work. By focusing on stakeholders and their interests, this book analyzes the value propositions of the buyers and sellers of healthcare products and services along with the interests of patients. The book begins with a presentation of frameworks for understanding the structure of the healthcare system and its dynamic stakeholder inter-relationships. The chapters that follow each begin with their social and historical origins, so the reader can fully appreciate how that area evolved. The next sections on each topic describe the current environment and opportunities for improvement. Throughout, the learning objectives focus on three areas: frameworks for understanding issues, essential factual knowledge, and resources to keep the reader keep up to date. Healthcare is a rapidly evolving field, due to the regulatory and business environments as well as the advance of science. To keep the content current, online updates are provided at: healthcareinsights.md. This website also offers a weekday blog of important/interesting news and teaching notes/class discussion suggestions for instructors who use the book as a text. The U.S. Health Care System: Origins, Organization and Opportunities is an ideal textbook for healthcare courses in MBA, MPH, MHA, and public policy/administration programs. In piloting the content, over the past several years the author has successfully used drafts of chapters in his Healthcare Systems course for MBA and MPH students at Northwestern University. The book is also useful for novice or seasoned suppliers, payers and providers who work across the healthcare field and want a wider or deeper understanding of the entire system.