Another promising antitrust enforcement step suggested by Richman and Havighurst could be to require hospitals and other provider entities to unbundle, at a purchaser's request, certain health care services so that the purchaser can negotiate their prices separately. They note that permitting a hospital monopolist to tie unrelated services together expands its reach, profitability, and longevity - at the expense of consumer welfare. Drawing the exact lines for when and how to exercise this "unbundling" enhancement of anti-tying antitrust enforcement needs further work (such as where to set market concentration thresholds for its application), but it is worthy of consideration for improved price competition. A different mechanism to battle local monopolies in health care would involve expanding the locus of competition. Future health policy should strive to encourage, not inhibit, interregional competition by reducing regulatory and reimbursement barriers to both domestic and international versions of "medical tourism." n13 Other "market opening" supply-side policies should extend to revision of scope of practice restrictions at the state level and reconsideration of current limits on expansion of physician-owned hospitals.
An important target for careful antitrust scrutiny involves the emergence of politically favored accountable care organizations (ACOs). Although promoted by the Obama administration as one of its magic bullets to reform our inefficient delivery system and reduce its projected future costs, ACOs could instead mutate into new vehicles to engineer and leverage greater monopoly power in already-concentrated health provider markets. The regulatory framework to govern ACOs has been revised since its initial incarnation but still needs to be monitored closely to ensure that promised efficiencies in health care coordination and integration are more likely to outweigh the danger of even further consolidation of provider market power, and that such organizations remain truly accountable to patients and market forces (and not just to political patrons).
Finally, we should remember that information is power within health care markets. The
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