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反垄断法与医生集体与第三方的谈判:相对价值指南的实例教训

Antitrust law and collective physician negotiations with third parties: the relative value guide object lesson.

作者信息

Pfizenmayer R F

出版信息

J Health Polit Policy Law. 1982 Spring;7(1):128-62. doi: 10.1215/03616878-7-1-128.

Abstract

This article examines the role of collective physician participation in the third-party reimbursement system. It critiques the Havighurst-Kissam analysis of the antitrust implications of professionally-developed relative value guides and, using lessons derived from the only litigated case on relative value guides, argues that collective physician input into third-party reimbursement plans can be made in a manner which is consistent with the antitrust law as and cost-containment policy objectives. In particular, collective "negotiations" by organized physicians with third parties, unaccompanied by fee agreements among physicians or by actual or threatened physician boycotts, are found to be procompetitive and hence permissible under the rule of reason.

摘要

本文探讨了医生集体参与第三方报销系统的作用。它批评了哈维赫斯特 - 基萨姆对专业制定的相对价值指南的反垄断影响的分析,并利用从唯一一起关于相对价值指南的诉讼案件中吸取的教训,认为医生集体参与第三方报销计划可以以一种符合反垄断法和成本控制政策目标的方式进行。特别是,有组织的医生与第三方进行的集体“谈判”,若没有医生之间的费用协议,也没有实际的或威胁性的医生抵制行为,则被认为具有促进竞争的作用,因此根据合理原则是允许的。

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