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.

Competition in the health sector: a historical perspective.

Viewed from a historical (and a theoretical) perspective, current "pro-competition" policy proposals are unbalanced in their emphasis on promoting "free market" behavior by consumers rather than by suppliers in the health services market. A comprehensive competition policy would require removal of supply-side restraints on health providers. Based on evidence about the evolution of restraints on physicians, dentists, and optometrists in one state, this article speculates on the political feasibility of removing supply-side restraints and thereby implementing a true "competition policy". Historically, the political environment and the alignment of interest groups have favored the promulgation of stringent restraints on health services providers. While the political environment is more receptive to challenges to those restraints today, there is little evidence that such challenges will succeed at either the state or federal level.

A case study in the politics of free-market health care.

Historically, most health occupations have developed legal and ethical restrictions on price advertising and other characteristics of "commercial" practice. Many of these regulations recently have come under critical scrutiny, on the grounds that they inhibit free-market health care delivery, thus keeping prices high, and productivity and innovation low. To help inform current health policy deliberations, we analyze the political history of anticompetitive regulations in one health occupation, optometry. Restrictions on commercial practice arose as a result of professional optometry's purge of commercial elements in the 1930s. Optometry's success in achieving commercial-practice restrictions at the state level was determined by the economic structure of the ophthalmic goods and services industry in each state in the 1930s, and by the political resources and organization of the competing interest groups. Efforts to deregulate health occupations will precipate political conflict to the extent that economic interests are threatened. Opposition to deregulation will be based overtly on the grounds that quality of care will deteriorate, and a significant political investment by proponents of free-market health care will be required to overcome such opposition.

The evolution of Oregon's Public Psychiatry Training Program.

Public psychiatry training in Oregon traces its roots to the community mental health movement of the 1960s and now includes a focus on training in the community and in state hospitals.