Glenn A. Melnick (
Katya Fonkych is a research associate at the Center for Health Financing, Policy, and Management, USC, and a senior researcher at the Massachusetts Health Policy Commission, in Boston.
Health Aff (Millwood). 2018 Sep;37(9):1417-1424. doi: 10.1377/hlthaff.2018.0418.
California became very successful in controlling rising health care costs by promoting price competition through market-based, managed care policies. However, recent data reveal that the state has not been able sustain its initial success in controlling growth in hospital prices. Two powerful trends emerged in California that eroded the conditions needed to sustain price competition. To ensure timely access to emergency hospital services, government regulators enacted regulations that had the unintended effect of giving hospitals tremendous leverage when contracting with health plans. Also, antitrust authorities allowed hospitals to consolidate into multihospital systems by adding members that were not direct competitors in local markets. The combined effect of these policies and consolidation trends was a substantial reduction in the competitiveness of provider markets in California, which reduced health plans' ability to leverage competitive provider markets and negotiate lower prices and other benefits for their members. Policy makers can and should act to restore competitive conditions.
加利福尼亚州通过推行基于市场的管理式医疗保健政策来促进价格竞争，从而非常成功地控制了不断上涨的医疗保健成本。然而，最近的数据显示，该州未能维持其在控制医院价格增长方面的初步成功。加利福尼亚州出现了两个强大的趋势，削弱了维持价格竞争所需的条件。为了确保及时获得紧急医院服务，政府监管机构制定了法规，这些法规产生了意想不到的效果，即在与医疗计划签订合同时，赋予了医院巨大的影响力。此外，反垄断当局允许医院通过加入在当地市场不是直接竞争对手的成员，合并为多医院系统。这些政策和合并趋势的综合影响是加利福尼亚州供应商市场的竞争力大幅下降，这降低了医疗计划利用竞争供应商市场的能力，并为其成员谈判更低的价格和其他福利。政策制定者可以而且应该采取行动来恢复竞争条件。
