common standards, may help us better performance on key public health measures and better treatment for common chronic conditions, such as hypertension and diabetes mellitus. Redundant requests to physicians and other providers of care by managed care organizations to implement commonly accepted standards such as appropriate infection control procedures in private physician offices, can and should be simplified by common programs that promote the accepted standard and require compliance with it. I believe there is a difference between social purpose of health care and other forms of commerce that may justify some changes in antitrust laws for health care. We must make sure legal mechanisms are available to competitors to cooperate in such areas where the common good justifies it.

There are new opportunities for promoting both new forms of competition and new forms of collaboration in health care. Competition on price, and quality as documented by standardized survey and measurement tools, is being encouraged at the level of provider care systems in Minnesota and New York. Organized, risk bearing, provider care systems are emerging from a cottage industry of individual entrepreneurial health care professionals.

Opportunities for collaboration exist in furthering public health and in conducting research. On the public health side, a common immunization registry would fulfill the need to monitor the immunization status of a population as well as assist competing health plans to monitor and improve the immunization status of the populations they enroll. From a research perspective, collaboration offers the opportunity to increase the effectiveness of care for patients with rare conditions undergoing experimental therapy.

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