Feldman R D, Wholey D R, Christianson J B
Health Services Research and Policy Division, University of Minnesota School of Public Health, USA.
Health Aff (Millwood). 1999 Jul-Aug;18(4):96-104. doi: 10.1377/hlthaff.18.4.96.
The health maintenance organization (HMO) industry has undergone a wave of national consolidations in recent years. The most notable among these were between United HealthCare and MetraHealth (1995), PacifiCare Health Systems and FHP International (1996), Aetna Life and Casualty and U.S. Healthcare (1996), and Aetna and Prudential's health care unit (1999). This paper examines HMO consolidation from 1994 to 1997, looking first at concentration at the national level and then at the consequences of national consolidations for local markets. Whereas earlier mergers may have caused only a small increase in the type of local market concentration that may increase prices, later and currently proposed mergers may be motivated by considerations of increasing local market concentration. However, the concentration-increasing effect of national mergers was offset by the concentration-decreasing effect of HMO entry and growth. The analyses suggest that antitrust policy still has a role to play in ensuring that HMO markets remain open to new entry and in evaluating the effect of national mergers on local market concentration.
近年来，健康维护组织（HMO）行业经历了一轮全国性的合并浪潮。其中最引人注目的合并包括联合健康保险公司（United HealthCare）与美特拉健康保险公司（MetraHealth）（1995年）、太平洋保健系统公司（PacifiCare Health Systems）与FHP国际公司（FHP International）（1996年）、安泰人寿保险公司（Aetna Life and Casualty）与美国医疗保健公司（U.S. Healthcare）（1996年）以及安泰保险公司（Aetna）与保诚保险公司（Prudential）的医疗保健部门（1999年）。本文考察了1994年至1997年期间HMO的合并情况，首先着眼于全国层面的集中度，然后分析全国性合并对地方市场的影响。早期的合并可能只会使可能导致价格上涨的地方市场集中度略有上升，而后来及目前提议的合并可能是出于提高地方市场集中度的考虑。然而，全国性合并带来的集中度上升效应被HMO进入市场及业务增长所带来的集中度下降效应所抵消。分析表明，反垄断政策在确保HMO市场对新进入者保持开放以及评估全国性合并对地方市场集中度的影响方面仍可发挥作用。
