Greenberg W
George Washington University, Washington, DC 20052, USA.
Health Serv Res. 1998 Dec;33(5 Pt 2):1461-76.
Antitrust enforcement can improve the performance of large, vertically integrated physician-hospital organizations (PHOs). Objective: To examine the recent court decisions in the Blue Cross and Blue Shield United of Wisconsin v. Marshfield Clinic antitrust case to understand better the benefits and costs of vertical integration in healthcare.
Vertical integration in the Marshfield Clinic may have had the benefits of reducing transactions and uncertainty costs while improving the coordination between ambulatory and inpatient visits, but at the cost of Marshfield Clinic's monopolizing of physician services and foreclosing of HMO entry in northwest Wisconsin. The denial of hospital staff privileges to non-Marshfield Clinic physicians combined with certificate-of-need regulations impeded physician entry and solidified Marshfield Clinic's monopoly position. Enforcement efforts of recent antitrust guidelines by the U.S. Department of Justice and the Federal Trade Commission will need to address carefully the benefits and costs of vertically integrated systems.
反垄断执法能够改善大型纵向一体化的医师-医院组织（PHOs）的绩效。目的：研究威斯康星州蓝十字与蓝盾联合公司诉马什菲尔德诊所反垄断案最近的法院判决，以便更好地理解医疗保健领域纵向一体化的收益与成本。
马什菲尔德诊所的纵向一体化可能具有降低交易和不确定性成本的益处，同时改善门诊与住院诊疗之间的协调，但代价是马什菲尔德诊所垄断医师服务以及阻止健康维护组织（HMO）进入威斯康星州西北部。拒绝给予非马什菲尔德诊所医师医院员工特权，再加上需求证明规定，阻碍了医师进入并巩固了马什菲尔德诊所的垄断地位。美国司法部和联邦贸易委员会近期反垄断指南的执法工作需要谨慎处理纵向一体化系统的收益与成本。
