Federal Trade Commission drops challenge to California hospital acquisition

The significance of patient outmigration patterns, third-party payor reaction, and post-merger cost savings have been regularly argued by defense counsel and hospitals as important consideration in the antitrust evaluation of hospital mergers. The reliance placed by the Commission on these factors in its Ukiah decision is a welcome confirmation that the antitrust agencies are increasingly sensitive to these aspects of hospital mergers, reflecting a more sophisticated understanding of the health care market than was suggested by the staff's more mechanical evaluative approach. Hospitals and their counsel should therefore prepare for and document these factors if they anticipate antitrust agency scrutiny of a proposed acquisition or merger.     

Why don't courts treat hospitals like tanks for liquefied gases? Some reflections on health care antitrust enforcement

In this article, I use the Federal Trade Commission and the Department of Justice 2004 report Improving Health Care: A Dose of Competition as an occasion to comment on two specific issues that have arisen in health care antitrust: the recent string of losses by the enforcement agencies in hospital merger cases and an antitrust exemption for physicians to bargain collectively with health insurers. One of the more salient facts about health care antitrust enforcement is the notable recent lack of success of the enforcement agencies in hospital merger cases. This may be due to judges and juries holding views of hospital markets as being different from markets for other goods and services. My conclusion is that hospitals are an industry with unique attributes, but nothing about the specifics of the health care industry suggests that the unregulated use of market power in this industry is socially beneficial. As a consequence, the antitrust laws should be enforced here as in any other industry. Countervailing power is an issue that has come to the fore in health care antitrust. Physicians have explicitly asked for legislative exemption from the antitrust laws in order to bargain collectively with insurance companies, as a means of counteracting insurers' monopsony power. It is not clear that health insurers possess significant monopsony power. Even if they do, bestowing monopoly power on physicians will not necessarily improve matters. Active antitrust enforcement in insurance markets is the correct response, not blanket exemptions for providers.     

Price competition in hospital markets: the significance of managed care

Anticompetitive conduct in the healthcare industry is often hard to detect, and has been ignored by some courts that appear to lack an understanding of managed care and its significance in maintaining price competition. These courts have adopted an approach that is far too historical and mechanistic, and is characterized by outdated factors analyzed in isolation from each other. In order to preserve effective price competition, the courts should embrace a realistic analysis that accurately reflects the workings of health services markets. This article describes the many facets of market power and anticompetitive conduct, and how they affect healthcare prices. The author then tums to an analysis of two recent hospital antitrust decisions, and critiques them for their failure to properly analyze the dynamics of local hospital markets.     

Community control and pricing patterns of nonprofit hospitals: An antitrust analysis

Traditional control of nonprofit hospitals by the communities they serve has been offered as justification for restraining antitrust enforcement of mergers that involve nonprofit hospitals. The community is arguably a constraint on a nonprofit's inclination to exercise market power in the form of higher prices; however, community control is likely to be attenuated for hospitals that through merger or acquisition become members of hospital systems--particularly those that operate on a regional or multiregional basis. We report findings from a study in which we examined empirically the relationship between market concentration and pricing patterns for three types of nonprofit hospitals that are distinguishable based on degree of community control: an independent hospital, a member of a local hospital system, and a member of a nonlocal hospital system. Study results indicated that when conditions existed to create a more concentrated market, (1) all three types of nonprofit hospitals exercised market power in the form of higher prices, and (2) hospitals that were members of nonlocal systems were more aggressive in exercising market power than were either independent or local system hospitals. The results have important implications for antitrust enforcement policy.     

Anticompetitive Employment

Scholars, antitrust agencies, and policy makers have historically paid little attention to anticompetitive practices in labor markets. This was largely due a misconception that antitrust law is meant to govern conventional markets in which goods and services trade, rather than govern labor markets. Antitrust law may also offer a poor remedy to redress employers who enter no-poaching agreements or otherwise impair competition. The primary tension involves antitrust's purpose, which is to promote “consumer welfare.” To identify whether conduct eroded consumer welfare, courts tend to scrutinize whether prices increased. But here, lessening wages can enable firms to sell goods at cheaper prices, benefiting consumers. Another issue is that the typical restraint affects only a smattering of workers instead of lessening wages throughout the greater market. This article uses empirical analyses to show that antitrust should promote labor's welfare as it does consumer welfare, and it argues that enforcement must condemn labor cartels as per se illegal. The research demonstrates that labor cartels are more pernicious than restraints in product markets, as employers can lessen wages with less effort than in product markets. Antitrust should even proscribe no-poaching agreements formed for a legitimate purpose (e.g., to protect trade secrets) because employers could have achieved the same goals using less coercive means; the noncompete agreement, at least, provides labor with a semblance of notice and bargaining power without drawing antitrust scrutiny. The prohibition of labor cartels would thus promote competition and consumer welfare, especially in minimum wage labor markets.     

Toward a definitive antitrust standard for nonprofit hospital mergers

Despite decades of federal and state regulatory efforts to encourage more efficient utilization of hospital resources, recent federal antitrust enforcement actions assert that nonprofit hospital mergers are detrimental to consumers. This policy, however, is derived from misguided attempts to apply the economic assumptions of for-profit industries to the nonprofit hospital sector and to extend statutes enacted to restrain national economic concentration to local nonprofit enterprises. This paper concludes that a rational antitrust enforcement policy that recognizes the unique characteristics of hospital markets can be described within the confines of existing antitrust statutes.     

Restraint of trade through hospital exclusive contracts: an economic appraisal of the legal theory

The growth of antitrust litigation in the health care area reflects the developing consensus that competition is as powerful a force in health care as it is elsewhere in the economy. Exclusive contracts between hospitals and hospital-based physician specialists have been prominent among the contested practices. Challenges to these arrangements uniformly assert an injury to competition; for example, that the contracts are a means of gaining monopoly power in some market. But these claims have lacked a solid theoretical basis for general hostility to exclusive dealing of this sort. This article describes several economic considerations that are fundamental to an analysis of this contractual phenomenon. These considerations imply that there is no general economic basis for suspicion, and that the circumstances under which suspicion would be warranted are likely to be rare.     

Ball Memorial Hospital: Section 2 Sherman Act analysis in the alternative health care delivery market

In 1986, the Seventh Circuit Court of Appeals in Ball Memorial Hospital v. Mutual Hospital Insurance denied an injunction sought under the antitrust laws by the plaintiffs, eighty acute care hospitals, which would have precluded Blue Cross and Blue Shield of Indiana from implementing a Preferred Provider Organization. The Ball court used a conservative economic analysis to deny the injunction and failed to consider many industry-specific factors. This Note examines these factors and challenges the Ball court's position by arguing that antitrust scrutiny of alternative health care delivery markets must go beyond the court's narrow approach.     

Doctors and hospitals: an antitrust perspective on traditional relationships

Under new pressures for cost containment, hospitals are increasingly asserting interests that conflict with those of physicians. Professor Havighurst argues that legal rules under which practitioners have challenged denials of hospital admitting privileges should be clarified in order that hospitals can more effectively carry out their new cost-containment and other responsibilities. He invokes antitrust law's "essential-facilities" doctrine to protect those abused by their competitors on a hospital staff, but he contends that, if a hospital participates in decisionmaking as an independent actor--even though it acts in concert with its physicians--, antitrust courts should lower the level of scrutiny to a point at which most challenges can be dismissed summarily. He analogizes restraints imposed by hospitals on competition between health professionals to vertical restraints of other kinds, and draws conclusions critical of doctrine traditionally applicable to the latter.     

BIDDING MARKETS

The existence of a "bidding market" is commonly cited as a reasonto tolerate the creation or maintenance of highly concentratedmarkets. We discuss three erroneous arguments to that effect:the "consultants' fallacy" that "market power is impossible,"the "academics' fallacy" that (often) "market power does notmatter," and the "regulators' fallacy" that "intervention againstpernicious market power is unnecessary," in markets characterizedby auctions or bidding processes.Furthermore we argue that theterm "bidding market" as it is widely used in antitrust is unhelpfulor misleading. Auctions and bidding processes do have some specialfeatures—including their price formation processes, common-valuesbehavior, and bid-taker power—but the significance ofthese features has been overemphasized, and they often implya need for stricter rather than more lenient competition policy.     

搜索引擎与滥用市场支配地位

从反垄断法的角度出发,现有大型搜索引擎运营商们是否实施了违法行为,一直都是各国学者及实务界关注的焦点,其中最主要的争议问题即这些运营商们是否滥用了市场支配地位。根据我国反垄断法相关规定,结合我国学者论述,并参考欧盟相关理论和实践,着眼于我国目前相关诉讼和指责等实际情况,探讨了诸如相关市场界定争议、市场支配地位证明、滥用行为是否可能和在反垄断法意义上是否成立等问题。虽然理论上存在基于滥用行为而限制竞争的可能性,但从中国和欧盟反垄断法的具体规定,尤其是举证责任问题的规定上看,在实践中确实认定搜索引擎运营商滥用市场支配地位仍需时日。     

The joint venture alternative to mergers

However, while a joint venture may be "safe" from antitrust challenge, it is not without some practical difficulties, especially with respect to consolidating services at one location or jointly offering services provided at multiple facilities. These practical concerns include: 1. Who will exercise operational management of the joint venture? 2. How will the joint venture deal with different pricing for services that will be provided at multiple locations? 3. What criteria will be used to decide the location at which consolidated tertiary services will be offered? 4. In what circumstances can the joint venture be unwound, either in its entirety or as to discrete functions? When clinical services have been consolidated at one location, there is an appropriate concern by the other hospital that it will be unable to provide or re-enter the market for those services if the joint venture dissolves. These operational concerns, of course, are not addressed in the Consent Decree. Thus, even if a joint venture relationship survives antitrust scrutiny, the parties must still negotiate and resolve these operational issues in order for the joint venture to be viable.     

Applying antitrust law to nonprofit healthcare entities: arguments for a greater attention to detail

This Article begins with an antitrust primer, then analyzes the appropriate application of antitrust principles to nonprofit healthcare providers. In light of the inherent charitable character of nonprofit healthcare providers, the author contends that the government and the courts should accord some deference to nonprofit hospitals when they are seeking approval of mergers. To date, this has not generally been the case, although a few recent court decisions have rested their approval of mergers, in part, upon the nonprofit character of the merging entities. The author, in particular, believes the paradigmatic local nonprofit hospital with a community board is less likely than a for-profit hospital to abuse any market power that it may obtain through a merger; consequently, any such merger should not be analyzed solely under the traditional presumptions of antitrust jurisprudence. Rather, the premerger analysis should involve meaningful consideration of the hospital's charitable character.     

20世纪90年代以来的合并控制理论探析

为了适应 20世纪 90年代以来并购活动的日益增长,规制者运用“革新市场”和“单方效果”来支持积极的反托拉斯执法活动。“革新市场”理论通过对一个合并对相关市场上的研究和发展的影响来评估技术领先企业之间的合并。“单方效果”理论根据合并企业独自对相关市场上价格产生影响的能力来评估一个合并。     

Redressing the imbalanced political market for health policy: a role for the state attorney general?

In current discussions of "procompetitive" approaches to health policy, the enforcement of antitrust laws in health care markets is a strategy that has attracted increasing attention: the filing of consumer-oriented health suits provides a means to "redress" the typically imbalanced "political market" in health policy. This study examines an important aspect of the antitrust enforcement process, the decision by a state attorney general to undertake an aggressive antitrust enforcement program in the health area. Three variables were found to explain this decision: the political needs of a "politician-supplier," the organizational resources of a strategic institutional position, and the availability of a relatively favorable policy arena. An assessment of the future role of state attorneys general in this area suggests that their health antitrust initiatives will increase, but that various political and resource constraints are likely to inhibit their aggressiveness in pursuing these actions.     

垄断法下的相关数据市场研究

数据是互联网平台经济的利润中心与关键驱动力.在对平台经济的反垄断审查中,相关机构很少将数据要素纳入审查分析范围.平台经济的反垄断审查分析中需重新审视数据要素的价值.互联网平台是在线经济结构的最有影响力的参与者.与传统的管道业务模型不同,平台市场是多方且相互依存的市场.追求规模化意味着平台须尽一切努力获取数据资源.数据不...     

后TRIPs时代我国知识产权反垄断的立法价值选择

后TRIPs时代,我国知识产权保护水平已与世界先进国家标准接轨;但我国自主创新比例却相当低,知识产权已经成为国外知识产权权利人进人中国后封闭市场、排挤竞争对手的工具。一国的知识产权反垄断立法价值取向应当与其具体的国内外经济政治环境相适应,反映其“本土性”、“时代性”的特点。作为拥有知识霸权的发达国家,已放松了对知识产权反垄断的规制,持有利于知识产权人的立场;他们的立场与技术落后的发展中国家截然不同。我国在知识产权反垄断立法过程中,当务之急不是去寻求国外的立法技术移植;而是从战略高度确定知识产权反垄断的立法价值取向,即以社会公益为本位,强化反垄断规制。     

The competitive impact of health maintenance organizations on hospital finances: an exploratory study

In this study we explore whether HMO-induced competition has contained expenditures in Minneapolis/St. Paul hospitals. Specifically, we assessed the impact of HMOs on revenue, cost, and net income per admission in Twin Cities hospitals from 1979 to 1981. Some HMOs have obtained negotiated discounts from hospitals. We found that hospitals which gave larger discounts did not have lower costs per admission. This finding suggest that discounts do not force hospitals to operate more efficiently. In addition, hospitals with a large share of patients from HMOs or government Medicare and Medicaid programs did not have lower costs per admission than other hospitals during the years from 1979 to 1981. This finding casts doubt on the claim that discounts are justified by lower costs for HMO or government patients. Finally, neither HMO market share nor discounts had an adverse effect on hospital profits. During the three years studied, hospital profits in the Twin Cities showed an upward trend. This study concludes that if competition is to succeed it must encompass more than HMOs. HMOs may be important, but they are only one agent in the market. Thus, public policy created to induce competition must go beyond the simple stimulus of HMO growth.     

Special report on antitrust. Criminal antitrust enforcement--when, who, and why?

Government civil antitrust enforcement and private antitrust litigation are not always easy to avoid, because even innocent actions can be alleged to have been improperly motivated or to adversely affect competition. On the other hand, criminal antitrust violations can be readily avoided by following a set of basic, simple, and easy to remember rules: 1. Providers should not agree with competing or potentially competing providers on any terms of price, quantity, or quality of service; 2. Providers should not agree with competing or potentially competing providers as to which patients (or payors) will be served, what kinds of services will be offered, or where to locate offices or facilities; and 3. Providers should not agree with competing or potentially competing providers to refuse to offer services to payors or other alternative delivery systems. There are circumstances in which exceptions to these general rules are appropriate, such as when an agreement among providers is necessary in order to participate in a legitimate alternative delivery system, preferred provider organization, or individual practice association. However, these exceptions are narrow and technical. The best advice is the following warning to providers by Charles F. Rule, former U.S. Assistant Attorney General for antitrust: "You should never act as if an exception applies until after you have consulted an experienced antitrust lawyer or until you have obtained adequate assurance that competent counsel has structured the system to eliminate antitrust problems."     

经营者集中的反垄断审查制度刍议简

市场经济大背景下,经营者集中活动无疑给参与者和整个市场带来了许多机遇,但与此同时也给良好市场竞争秩序的保持带来了挑战.经营者集中反垄断审查制度因此应运而生.这一制度广泛借鉴了他国优秀的立法与实践成果,满足了反垄断法内在的价值追求,但在申报标准、审查程序、审查标准等方面仍有不完整、不完善和值得商榷之处.