Montague Alexandra D, Davison Robin L, Gudiksen Katherine L, King Jaime S
The Source on Healthcare Price and Competition, University of California College of the Law, San Francisco, San Francisco, CA, United States.
Faculty of Law, University of Auckland, Auckland, New Zealand.
Front Public Health. 2023 Aug 16;11:1220624. doi: 10.3389/fpubh.2023.1220624. eCollection 2023.
The widespread consolidation of health systems, hospitals, and physicians has contributed to the high price of healthcare across the United States. While federal antitrust enforcers continue to play an important role in overseeing large mergers, acquisitions, and other consolidating transactions of major healthcare providers, state oversight over healthcare markets is essential to slow consolidation more broadly and address market failures across the country. State laws govern the scope of authority held by state attorneys general and other state agencies to receive notice of, review, and approve, conditionally approve, or block healthcare provider transactions, which can significantly impact the breadth and content of oversight. While blocking potentially anticompetitive transactions can help states maintain any competitive forces that remain in the market, in some situations, approving a transaction with conditions may be the best path forward. Applying conditions to transactions may allow state officials to oversee and govern the behavior of providers post-transaction while states pursue other legislative fixes. Although the use of conditions is a relatively common practice at the state level, little research has been done to explore their use among states. Following a search in all 50 states, this paper examines decisions from state officials imposing conditions intended to address the impacts of transactions on healthcare price, access, and quality and provides recommendations for the effective use of conditions moving forward.
医疗系统、医院和医生的广泛合并导致了美国医疗保健费用居高不下。虽然联邦反垄断执法机构在监督大型医疗保健供应商的合并、收购及其他整合交易方面继续发挥重要作用，但州政府对医疗市场的监管对于更广泛地减缓合并进程以及解决全国范围内的市场失灵问题至关重要。州法律规定了州检察长和其他州机构在接收医疗保健供应商交易通知、审查、批准、有条件批准或阻止这些交易方面的权限范围，这会对监管的广度和内容产生重大影响。虽然阻止潜在的反竞争交易有助于各州维持市场中尚存的竞争力量，但在某些情况下，有条件地批准交易可能是最佳选择。对交易施加条件可能使州官员在交易完成后监督和管理供应商的行为，同时各州寻求其他立法补救措施。尽管在州一级使用条件是一种相对常见的做法，但很少有研究探讨其在各州的使用情况。在对所有50个州进行搜索之后，本文研究了州官员为应对交易对医疗价格、可及性和质量的影响而施加条件的决定，并为今后有效使用这些条件提供了建议。
