Physician agreements to control medical prepayment plans: Federal Trade Commission. Adoption and publication of enforcement policy with respect to physician agreements to control medical prepayment plans.

The Federal Trade Commission has adopted, and is publishing with this notice, a statement of enforcement policy with respect to physician agreements to control medical prepayment plans. The statement sets forth the general approach the Commission intends to use in its case-by-case enforcement program for evaluating physician agreements to form, operate, or control such plans and for evaluating the practices of plans that are controlled by a group of physicians.

Physician fee-setting requires scrutiny.

To avoid antitrust liability from physician fee-setting in HMOs and PPOs, participating physicians should share the risk of profit and loss. "Health Law" is a regular feature of Physician Executive contributed by the law firm of Epstein Becker and Green, P.C. Douglas A. Hastings, Esq., a partner in the firm's Washington, D.C., offices serves as column editor.

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.

On the other hand: some comments on Sigelman's palmistry.

KIE: Responding to a negative assessment by Daniel W. Sigelman of the social impact of current efforts to promote competition in the medical marketplace, Blumstein argues that, since the competitive strategy is designed to rationalize health care delivery, it should be evaluated independently of the issue of financing health care for the poor.^ieng

Antitrust law and collective physician negotiations with third parties: the relative value guide object lesson.

This article examines the role of collective physician participation in the third-party reimbursement system. It critiques the Havighurst-Kissam analysis of the antitrust implications of professionally-developed relative value guides and, using lessons derived from the only litigated case on relative value guides, argues that collective physician input into third-party reimbursement plans can be made in a manner which is consistent with the antitrust law as and cost-containment policy objectives. In particular, collective "negotiations" by organized physicians with third parties, unaccompanied by fee agreements among physicians or by actual or threatened physician boycotts, are found to be procompetitive and hence permissible under the rule of reason.

Exclusive contracts under antitrust attack.

Physicians excluded from hospitals by reason of exclusive contracts are increasingly challenging these arrangements under the antitrust laws. With the exception of the recent case of Hyde v. Jefferson Parish Hospital District No. 2, the cases reject antitrust attacks on exclusive contracts between hospitals and physicians.

Implementing a competitive medical care system through public policy.

This paper seeks to clarify so-called competition strategies for medical care, and to present a more flexible approach for public policy to encourage competition. In so doing, it appears useful to divide a competition strategy into two parts: (1)a structurally sound market mode for the future medical delivery and financing system, and (2) a strategy to implement the chosen model. Policymakers may choose any model that satisfies that structural conditions of a sound market. After listing there principal conditions, this paper presents two distant market models that satisfy them in entirely different ways and a third model that combines the first two. Once a specific market model is chosen, policymakers may choose among a variety of ways to implement it. Some implementation strategies require coercive legislation, others rely more on persuasive leadership, pressures, and incentives. The paper points out that all of these strategies must address certain common action areas: it then proposes one implementation strategy in some detail and uses it to illustrate a way to address each of these area. Although it certainly is not the only possible strategy, the proposal would appear to be practical approach for implementing effective competition.

Palm-reading the invisible hand: a critical examination of pro-competitive reform proposals.

KIE: The current emphasis of government policymakers on stemming health care cost inflation by means of marketplace competition rather than regulation is assessed in terms of its potential impact on those covered by employer-paid health insurance, the poor, and the elderly. The competitive strategy is seen as creating serious problems of equity and access to care for the poor and for those at high medical risk.^ieng