Thomas L. Greaney (
Health Aff (Millwood). 2017 Sep 1;36(9):1564-1571. doi: 10.1377/hlthaff.2017.0558.
Provider market power is a powerful driver of high health care costs in the United States. Despite decades of antitrust litigation and regulatory interventions, the problem has worsened and threatens to undermine the benefits of market-based policies. A critical but neglected challenge for all health care reform proposals relying on market competition to address costs is finding effective tools to address the extant market power of dominant hospitals, hospital systems, and many specialty physician practices. This article analyzes the principal market-oriented approaches that have been used in the past and proposed for the future. It argues that antitrust law has an important but constrained role to play and has proved to be especially inept in dealing with extant market power. It finds serious deficiencies in the conduct decrees imposed by some courts and in open-ended regulatory regimes such as those established by Certificate of Public Advantage laws. Although not without administrative complications, policies that target providers who possess market power by capping prices may be the most effective means to control costs and retain the benefits of a competitive delivery system.
医疗机构市场势力是造成美国医疗保健费用居高不下的重要因素。尽管反垄断诉讼和监管干预已经持续了几十年，但这一问题仍在恶化，并有可能破坏基于市场的政策的效益。对于所有依赖市场竞争来解决成本问题的医疗改革提案来说，一个关键但被忽视的挑战是找到有效的工具来解决占主导地位的医院、医院系统和许多专科医生实践的现有市场势力。本文分析了过去和未来提出的主要面向市场的方法。它认为，反垄断法可以发挥重要但受到限制的作用，并且在处理现有市场势力方面已经被证明特别无能。它发现一些法院实施的行为命令以及公开的监管制度（如公共优势证书法所建立的制度）存在严重缺陷。尽管存在行政上的复杂性，但通过设定价格上限来针对拥有市场势力的供应商的政策可能是控制成本和保留竞争提供系统效益的最有效手段。
