Whither Antitrust? The Uncertain Future Of Competition Law In Health Care

Greaney, Thomas L.

doi:10.1377/hlthaff.21.2.185

Cited by 14 publications

(6 citation statements)

References 10 publications

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“…For the professional occupation, autonomy is the ability to establish, monitor, and enforce its own membership criteria and work standards. In the Anglo‐American context, this entails special legal privileges – in effect, a state‐sanctioned monopoly, expressed in a license or charter, and codified as an exception to anti‐trust law (now eroding: see Greaney, , and discussion below): the state thus plays a critical role in the constitution of the professions (Freidson, ). As a result, and in contradistinction to the model of pure and perfect competition, the market for professional services is characterized by occupational closure (Larson, ) with high, institutionalized barriers to entry, and with professions regulating their own members' behaviour.…”

Section: Individual Professionalsmentioning

confidence: 99%

The Mutation of Professionalism as a Contested Diffusion Process: Clinical Guidelines as Carriers of Institutional Change in Medicine

Adler

Kwon

2013

J Management Studies

103

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The Anglo‐American institution of the profession is mutating: we propose to analyse this mutation as a contested diffusion process that spreads new organizing practices among professionals. We offer an integrated account of the roles played in this diffusion/mutation process by facilitating and impeding factors at three levels: individual professionals (their autonomy, expertise, values, identities, and ties), professional organizations (their strategies, structures, cultures, skills, and systems), and the broader institutional field (professional associations, accountability demands, and competition). At the occupational and organizational level, we show how the distinctive and evolving features of professionalism moderate the mechanisms found in prior research on diffusion in other, non‐professional settings; and at the field level, we show how field‐level forces moderate the impact of professionalism on these diffusion dynamics. Changes at each of these levels interact with changes at the others, with influences flowing both downward and upward. We ground and illustrate this theoretical synthesis with evidence from the case of clinical guidelines as carriers of institutional change in the medical profession.

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Section: Individual Professionalsmentioning

confidence: 99%

The Mutation of Professionalism as a Contested Diffusion Process: Clinical Guidelines as Carriers of Institutional Change in Medicine

Adler

Kwon

2013

J Management Studies

103

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“…The courts' rulings effectively implied that hospital were to be held to a more lenient antitrust standard than other industries (Greaney, 2002 (1997)). If the use of consultants is driven by management styles and those styles are unrelated to other supply or demand shocks, it provides an account of the variation in merger activity that is exogenous in our empirical specifications.…”

Section: Identificationmentioning

confidence: 99%

The Welfare Consequences of Hospital Mergers

Town¹,

Wholey²,

Feldman³

et al. 2006

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In the 1990s the US hospital industry consolidated. This paper estimates the impact of the wave of hospital mergers on welfare focusing on the impact on consumer surplus for the under-65 population. For the purposes of quantifying the price impact of consolidations, hospitals are modeled as an input to the production of health insurance for the under-65 population. The estimates indicate that the aggregate magnitude of the impact of hospital mergers is modest but not trivial. In 2001, average HMO premiums are estimated to be 3.2% higher than they would have been absent any hospital merger activity during the 1990s. In 2003, we estimate that because of hospital mergers private insurance rolls declined by approximately .3 percentage points or approximately 695,000 lives with the vast majority of those who lost private insurance joining the ranks of the uninsured. Our estimates imply that hospital mergers resulted in a cumulative consumer surplus loss of over $42.2 billion between 1990 and 2001. It is estimated that all but a modest $95.4 million of the loss in consumer surplus is transferred from consumers to providers.

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“…A flurry of mergers and closures in the 1990s consolidated the bargaining power of hospitals, empowering them to withstand pressure from health plans and push prices back up (Strunk et al 2001;Cuellar and Gertler 2005;Vogt and Town 2006). Although the antitrust enforcement agencies successfully resisted some hospital mergers in the early 1990s, they lost a string of merger cases in the late 1990s and have largely abandoned enforcement in the hospital sphere since (Bloch and Falk 1994;Greaney 2002).…”

Section: Managed Care and Regulatory Responsesmentioning

confidence: 99%