Antitrust and Health Care: Provider Controlled Health Plans and the Maricopa Decision

1982 ◽  
Vol 8 (3) ◽  
pp. 223-249
Author(s):  
Charles D. Weller
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Industry ◽  
Market Model ◽  
Medical Society ◽  
Independent Practice ◽  
Health Plans ◽  
Care Providers ◽  
Care Industry ◽  
Antitrust Analysis

AbstractThe health care industry is one which traditionally has discouraged its members from engaging in competition. For years, many within the profession have espoused a guild mentality and have viewed professional societies as the proper centers of health care’s economic universe. This guild mentality has recently been challenged by proponents of a market mentality, theoreticians who argue that limited combinations of health care providers called “health plans,” which serve insurance as well as service functions, can make the health care industry more efficient. Proponents of the guild mentality have been dealt a severe blow by the Supreme Court and its decision in Arizona v. Maricopa County Medical Society. There the Court found the price-fixing by two Arizona medical societies to be illegal per se under applicable antitrust law. This Article outlines the background on competition and the guild mentality in the health care industry. After a brief discussion of the standards of antitrust analysis, the Article analyzes the Maricopa case, by first summarizing the Court’s use of strict antitrust criteria, and then by extending the analysis to an application of a more lenient standard. Next, the Article compares the provider controlled independent practice association (“IPA”)—one form of insurance plan proposed by market model advocates—with the Maricopa-type plan. Finally, the Article concludes that, not only is the special form of IPA that qualifies as a “health plan” an excellent way to promote efficiency in the health care industry, but also its procompetitive goals and effect allow it to survive even the strictest, Maricopa-type antitrust scrutiny.

Examining Exclusionary Conduct of HMOs and PPOs: A Case Comment on Northwest Medical Laboratories v. Blue Cross and Blue Shield of Oregon

1991 ◽  
Vol 17 (3) ◽  
pp. 271-288
Author(s):  
Debra M. Levitt
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Industry ◽  
Medical Laboratory ◽  
Care Providers ◽  
Court Of Appeals ◽  
Medical Laboratories ◽  
Care Industry ◽  
Antitrust Analysis ◽  
Blue Shield

As the climate of the health care industry has changed to one of cost-containment and competition through the growth of HMOs and PPOs, health care providers have become the subjects of antitrust litigation. One such case, Northwest Medical Laboratories v. Blue Cross and Blue Shield of Oregon, involved a medical laboratory and a radiology center who claimed that they were victims of an illegal group boycott after defendant's pre-paid health plan denied them preferred provider status. The Oregon Court of Appeals, using the traditional antitrust analysis applied to other industries for decades, failed to consider the intricacies that exist within the health care industry. This result led to an inaccurate market share computation and an inadequate rule of reason analysis. This Comment examines the shortcomings of the Northwest Medical opinion and argues that, in applying the antitrust laws to the health care industry, courts in future cases must recognize and respect the unique features of the business of providing health care.

scholarly journals Exploring the Social Networks’ Use in the Health-Care Industry: A Multi-Level Analysis

2021 ◽  
Vol 18 (14) ◽  
pp. 7295
Author(s):  
Tommasina Pianese ◽  
Patrizia Belfiore
Keyword(s):  
Health Care ◽  
Social Networks ◽  
Health Care Providers ◽  
Health Care Industry ◽  
Future Research ◽  
Great Level ◽  
Care Providers ◽  
Care Industry ◽  
Multi Level ◽  
Video And Audio

The application of social networks in the health domain has become increasingly prevalent. They are web-based technologies which bring together a group of people and health-care providers having in common health-related interests, who share text, image, video and audio contents and interact with each other. This explains the increasing amount of attention paid to this topic by researchers who have investigated a variety of issues dealing with the specific applications in the health-care industry. The aim of this study is to systematize this fragmented body of literature, and provide a comprehensive and multi-level overview of the studies that has been carried out to date on social network uses in healthcare, taking into account the great level of diversity that characterizes this industry. To this end, we conduct a scoping review enabling to identify the major research streams, whose aggregate knowledge are discussed according to three levels of analysis that reflect the viewpoints of the major actors using social networks for health-care purposes, i.e., governments, health-care providers (including health-care organizations and professionals) and social networks’ users (including ill patients and general public). We conclude by proposing directions for future research.

scholarly journals Social Media and Health Care, Part I: Literature Review of Social Media Use by Health Care Providers (Preprint)

2020 ◽  
Author(s):  
Deema Farsi
Keyword(s):  
Health Care ◽  
Social Media ◽  
Literature Review ◽  
Health Care Providers ◽  
Health Care Industry ◽  
Public Health Care ◽  
Care Providers ◽  
Care Industry ◽  
Digital World ◽  
The World

BACKGROUND As the world continues to advance technologically, social media (SM) is becoming an essential part of billions of people’s lives worldwide and is affecting almost every industry imaginable. As the world is becoming more digitally oriented, the health care industry is increasingly visualizing SM as an important channel for health care promotion, employment, recruiting new patients, marketing for health care providers (HCPs), building a better brand name, etc. HCPs are bound to ethical principles toward their colleagues, patients, and the public in the digital world as much as in the real world. OBJECTIVE This review aims to shed light on SM use worldwide and to discuss how it has been used as an essential tool in the health care industry from the perspective of HCPs. METHODS A literature review was conducted between March and April 2020 using MEDLINE, PubMed, Google Scholar, and Web of Science for all English-language medical studies that were published since 2007 and discussed SM use in any form for health care. Studies that were not in English, whose full text was not accessible, or that investigated patients’ perspectives were excluded from this part, as were reviews pertaining to ethical and legal considerations in SM use. RESULTS The initial search yielded 83 studies. More studies were included from article references, and a total of 158 studies were reviewed. SM uses were best categorized as health promotion, career development or practice promotion, recruitment, professional networking or destressing, medical education, telemedicine, scientific research, influencing health behavior, and public health care issues. CONCLUSIONS Multidimensional health care, including the pairing of health care with SM and other forms of communication, has been shown to be very successful. Striking the right balance between digital and traditional health care is important.

scholarly journals Market Receptiveness To Franchise Systems In The Health Care Industry

2011 ◽  
Vol 15 (3) ◽  
pp. 47
Author(s):  
Faye S. McIntyre ◽  
Faye W. Gilbert
Keyword(s):  
Health Care ◽  
Cluster Analysis ◽  
Health Care Providers ◽  
Health Care Systems ◽  
Health Care Industry ◽  
Demographic Characteristics ◽  
Care Providers ◽  
Care Industry ◽  
Care Systems ◽  
Sample Support

<span>In this study, cluster analysis is used to identify two consumer segments that differ in responsiveness toward franchised health care systems. These receptive and unreceptive clusters are differentiated in terms of the importance of health care constructs as well as in demographic characteristics. Younger, male respondents who live with a larger number of residents in the household may be the most receptive to franchise options, while the majority of all respondents seem open to the idea of franchised services. Further, results from this sample support the importance of competence, accessibility, empathy, and pricing to consumers in selecting health care providers, with less emphasis on local ownership.</span>

Malpractice & Negligence: Cal. Supreme Court Clarifies Negligence Provisions under State’s Elder Abuse Act

1999 ◽  
Vol 27 (2) ◽  
pp. 203-203
Author(s):  
Kendra Carlson
Keyword(s):  
Health Care ◽  
Supreme Court ◽  
Health Care Providers ◽  
Elder Abuse ◽  
Skilled Nursing Facility ◽  
Pressure Sores ◽  
Care Providers ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
The Supreme Court

The Supreme Court of California held, in Delaney v. Baker, 82 Cal. Rptr. 2d 610 (1999), that the heightened remedies available under the Elder Abuse Act (Act), Cal. Welf. & Inst. Code, §§ 15657,15657.2 (West 1998), apply to health care providers who engage in reckless neglect of an elder adult. The court interpreted two sections of the Act: (1) section 15657, which provides for enhanced remedies for reckless neglect; and (2) section 15657.2, which limits recovery for actions based on “professional negligence.” The court held that reckless neglect is distinct from professional negligence and therefore the restrictions on remedies against health care providers for professional negligence are inapplicable.Kay Delaney sued Meadowood, a skilled nursing facility (SNF), after a resident, her mother, died. Evidence at trial indicated that Rose Wallien, the decedent, was left lying in her own urine and feces for extended periods of time and had stage I11 and IV pressure sores on her ankles, feet, and buttocks at the time of her death.

Using Technology to Improve Access to Health Care for Culturally and Linguistically Diverse Populations

2012 ◽  
Vol 19 (3) ◽  
pp. 71-76 ◽  
Author(s):  
Pauline A. Mashima
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Access To Health Care ◽  
Underserved Populations ◽  
Linguistically Diverse ◽  
Care Providers ◽  
Department Of Health ◽  
Use Of Technology ◽  
Access To Health ◽  
Improve Access

Important initiatives in health care include (a) improving access to services for disadvantaged populations, (b) providing equal access for individuals with limited or non-English proficiency, and (c) ensuring cultural competence of health-care providers to facilitate effective services for individuals from diverse racial and ethnic backgrounds (U.S. Department of Health and Human Services, Office of Minority Health, 2001). This article provides a brief overview of the use of technology by speech-language pathologists and audiologists to extend their services to underserved populations who live in remote geographic areas, or when cultural and linguistic differences impact service delivery.

Interdisciplinary Therapy Assessments for the Older Adult

2012 ◽  
Vol 17 (1) ◽  
pp. 11-16
Author(s):  
Lynn Chatfield ◽  
Sandra Christos ◽  
Michael McGregor
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Standardized Testing ◽  
Health Care Providers ◽  
Outcome Measurement ◽  
Care Providers ◽  
Patient Centered ◽  
Screening Process ◽  
Evidenced Based ◽  
Changing Economy

In a changing economy and a changing industry, health care providers need to complete thorough, comprehensive, and efficient assessments that provide both an accurate depiction of the patient's deficits and a blueprint to the path of treatment for older adults. Through standardized testing and observations as well as the goals and evidenced-based treatment plans we have devised, health care providers can maximize outcomes and the functional levels of patients. In this article, we review an interdisciplinary assessment that involves speech-language pathology, occupational therapy, physical therapy, and respiratory therapy to work with older adults in health care settings. Using the approach, we will examine the benefits of collaboration between disciplines, an interdisciplinary screening process, and the importance of sharing information from comprehensive discipline-specific evaluations. We also will discuss the importance of having an understanding of the varied scopes of practice, the utilization of outcome measurement tools, and a patient-centered assessment approach to care.

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