Costillo L B
Health Matrix. 1986 Summer;4(2):22-5.
Preferred Provider Organizations (PPOs) have rapidly increased in number in response to soaring health care costs. Government antitrust enforcement agencies have encouraged the growth of PPOs because they help bring needed competition to the health care field. Antitrust problems in this area can generally be avoided by careful planning and counseling, but there are antitrust questions that are sometimes raised. Such issues include whether large PPOs can selectively deal with certain hospitals and refuse to deal with others; when exclusion of competing providers by provider-sponsored plans might be unlawful, and whether PPOs can be contract preclude participating providers from participating in competing plans. In analyzing such questions, one should look at whether there is an agreement among competing providers, whether the PPO has sufficient market power to cause anticompetitive effects, whether the restrictions in issue are motivated by an anti-competitive effects, whether the restrictions in issue are motivated by an anti-competitive purpose, and whether there are procompetitive (including efficiency enhancing) reasons for the arrangement. Another question that is frequently raised is when can provider members of a PPO jointly negotiate or set their reimbursement rates. The law is not clear on this subject. However, if the provider members of a PPO make significant financial contributions to the plan or otherwise share in the risk of adverse financial consequences resulting from the plan's operation, antitrust risks are lessened.
优选提供者组织（PPO）的数量因医疗保健成本飙升而迅速增加。政府反垄断执法机构鼓励PPO的发展，因为它们有助于给医疗保健领域带来必要的竞争。该领域的反垄断问题通常可以通过精心规划和咨询来避免，但有时也会引发反垄断问题。此类问题包括大型PPO是否可以有选择地与某些医院打交道而拒绝与其他医院打交道；提供者发起的计划排除竞争提供者何时可能不合法，以及PPO的合同是否可以排除参与的提供者参与竞争计划。在分析此类问题时，应考虑竞争提供者之间是否存在协议、PPO是否拥有足够的市场力量以产生反竞争效果、所涉限制是否出于反竞争目的、所涉限制是否出于反竞争动机，以及该安排是否有促进竞争（包括提高效率）的理由。另一个经常出现的问题是PPO的提供者成员何时可以联合谈判或设定他们的报销费率。法律在这个问题上并不明确。然而，如果PPO的提供者成员为该计划做出重大财务贡献或以其他方式分担该计划运营导致的不利财务后果的风险，反垄断风险就会降低。
