Conclusion

Antitrust violations are unlikely to be found if collaborating health plans seeking to raise the quality of health care can successfully confine their commercial (as opposed to their political) activities to developing and disseminating information that makes the competitive market (which depends fundamentally upon independent decision making by competing entities), work better and give greater weight to quality considerations in purchasing. Even though the law will continue to be vigilant against concerted action that interferes with the competitive process, there are many opportunities for useful collaboration by competing health plans. Although antitrust law has often been invoked by competitors injured by the circulation of information, modern courts are increasingly inclined to recognize that the Sherman Act was intended by Congress to protect "competition, not competitors."

A number of imperfections in the health care market could be addressed by collaborative action. Cooperation makes sense in several areas: when the science is compelling; when plans are common customers of a supplier as well as being competitors; and when adverse outcomes occur rarely, and competitors want to use scientific methods to help guide improvement.

The social purpose of health care may justify special treatment under antitrust laws. That is, it should be possible for competitors to cooperate where the common good justifies it. For example, appeals by multiple managed care organizations to office-based practices to implement commonly accepted standards of infection control can be simplified by collaboratively developed standards with which compliance is required.

Other opportunities for collaboration exist to promote public health and research. On the public health side, common immunization registries for public health and improved immunization status of health plan populations should be encouraged. From a research perspective the opportunity to collect the data on rare conditions or experimental treatment would serve the larger public good in addition to the individual needs of health plans.



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