Bluhm R J
Health Matrix. 1987 Fall;5(3):9-16.
The economic forces that bring the products of any market to fruition cannot proceed through history unrestrained. Society must maintain a sense of control over its economic market if the fruits of this market are to benefit all. The two forms of control that society has sought to apply in the past are (1) procompetitive restrictions and (2) anticompetitive regulations. The health care industry, however, is one which traditionally has been exempt from these private market restrictions. Throughout its history, the health care industry has discouraged its members from engaging in competition. For years, the industry had been allowed to develop its own peculiar "guild" system of economics. Today, this system is being challenged by proponents of a more traditional "market" approach. Under this new approach, a competitive market determines prices, encourages efficiency, maintains quality and spurs innovation. A response to this procompetitive system has been the advent of Preferred Provider Organizations (PPOs). Preferred Provider Organizations 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. A problem with the "encouragement" is that it frequently runs amuck of antitrust regulations. In these situations, one should look at whether there is agreement with Section 1 of the Sherman Act.
促使任何市场产品得以实现的经济力量，在历史进程中不可能不受限制地发展。如果市场成果要惠及所有人，社会就必须对其经济市场保持一种控制感。社会过去试图采用的两种控制形式是：（1）促进竞争的限制措施和（2）反竞争的监管规定。然而，医疗保健行业传统上一直不受这些私人市场限制的约束。在其整个历史中，医疗保健行业一直不鼓励其成员参与竞争。多年来，该行业一直被允许发展其独特的“行会”经济体系。如今，这种体系正受到更传统“市场”方法支持者的挑战。在这种新方法下，竞争市场决定价格、鼓励效率、维持质量并刺激创新。对这种促进竞争体系的一种回应是优选提供者组织（PPO）的出现。由于医疗保健成本飙升，优选提供者组织的数量迅速增加。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所需的竞争。这种“鼓励”存在的一个问题是，它经常违反反垄断法规。在这些情况下，人们应该审视是否符合《谢尔曼法》第一条的规定。
