Brent D. Fulton (
Jaime S. King is a professor of law and the John and Marylyn Mayo Chair in Health Law, Faculty of Law, University of Auckland, in Auckland, New Zealand.
Health Aff (Millwood). 2021 Dec;40(12):1836-1845. doi: 10.1377/hlthaff.2021.00781.
States can challenge proposed hospital mergers by using antitrust laws to prevent anticompetitive harms. This observational study examined additional state laws-principally charitable trust, nonprofit corporation, health and safety, and certificate-of-need laws-that can serve as complements and substitutes for antitrust laws by empowering states to be notified of, review, and challenge proposed hospital mergers through administrative processes. During the period 2010-19, 862 hospital mergers were proposed, but only forty-two (4.9 percent) were challenged by states, including thirty-five by states without federal involvement, of which twenty-five (71.4 percent) originated in the eight states with the most robust merger review authority. The twenty-five challenges resulted in two mergers being blocked; three being abandoned; and twenty being approved with conditions, including seven with competitive-impact conditions. Hospital market concentration and prices increased at similar rates in these eight states versus other states, potentially because most challenges allowed mergers to proceed with conditions that did not adequately address competitive concerns. Although these findings do not reveal an optimal state framework, elements of advanced state merger review authority may have the potential to improve poorly functioning hospital markets.
各州可以利用反垄断法来挑战拟议中的医院合并，以防止竞争受损。本观察性研究探讨了其他州的法律——主要是慈善信托、非营利公司、健康和安全以及需要证明的法律——通过授权各州通过行政程序通知、审查和挑战拟议中的医院合并，可以作为反垄断法的补充和替代，以增强各州的能力。在 2010 年至 2019 年期间，提出了 862 起医院合并，但只有 42 起（4.9%）受到各州的挑战，其中 35 起涉及没有联邦参与的州，其中 25 起（71.4%）源自合并审查权最强大的八个州。这 25 项挑战导致两项合并被阻止；三项被放弃；二十项被批准，但附有条件，其中七项附有竞争影响条件。在这八个州和其他州，医院市场的集中和价格以相似的速度增长，这可能是因为大多数挑战都允许合并有条件进行，而这些条件并没有充分解决竞争问题。尽管这些发现并没有揭示出一个最佳的州框架，但先进的州合并审查权的要素可能有潜力改善运作不佳的医院市场。
