The Privatization of Health Care Reform: Legal and Regulatory Perspectives

By M. Gregg Bloche | Go to book overview

6
MEDICAL ANTITRUST REFORM:
ARROW, COASE, AND THE
CHANGING STRUCTURE OF THE FIRM

Peter J. Hammer

The collapse of national health care reform has refocused attention on private markets as the primary force shaping the medical industry. The past two decades have witnessed a blizzard of entrepreneurial activity, marking fundamental changes in the way health care is financed and delivered. Physicians are forming new and larger groups. Hospitals are buying physician practices. Insurance companies are creating managed care networks that provide medical services. At the same time, an increasing number of health care providers are marketing their services on a prepaid basis in direct competition with traditional insurance companies. While it is sometimes difficult to move beyond the flood of various organizational acronyms, it is useful to make an economic distinction between integration and consolidation in medical markets.1 The dominant theme is integration: the creation of health plans that combine in a single entity (bound either by common ownership or contractual relations) the components of physician services, hospital services, and medical insurance. But also increasingly important is horizontal consolidation: collaborative arrangements within component parts, such as a merger between two hospitals, the formation of a new or larger physician group, or the combination of managed care plans and insurance companies.2

Integration reflects a fundamental reorganization of the firms providing health care services and financing. Increasingly, the function of selling medical insurance is being combined in-house with the function of delivering medical services.3

-113-

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