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Proposed antitrust exemption for physicians may alter the balance of power between doctors and health plans

Under current antitrust law, doctors are forbidden to join together to collectively negotiate with managed care or other health plans. This year 10 State legislatures introduced legislation, which is also being considered in the U.S. Congress, to exempt physicians from antitrust law so that they can negotiate with health plans.

Doctors claim that this exemption will enable them to enhance or at least preserve quality of care and will improve the patient-physician relationship. They assert that currently health plans can force them to accept unreasonably low fees that threaten health care quality and access to care. Critics portray the legislation as a thinly veiled attempt to enhance the economic power of physicians, which will prove costly to consumers and reduce the number of people who are able to afford health insurance.

In a recent paper, Fred J. Hellinger, Ph.D., of the Center for Organization and Delivery Studies, Agency for Healthcare Research and Quality, and Gary J. Young, Ph.D., J.D., of Boston University, examine the potential impact of physician antitrust exemption legislation on the balance of power between physicians and managed care plans. They describe two studies which concluded that proposed Federal legislation would increase health insurance premiums and physician fees. However, both studies had flaws, and neither they nor any other studies have examined the potentially beneficial impact of such legislation on quality and access to health care, according to the researchers.

In the view of Drs. Hellinger and Young, it is unlikely that enactment of State laws will appreciably alter the balance of power between doctors and managed care plans. Most State plans, like the one in Texas, would restrict the maximum size of the physician group and the minimum size of the managed care plans and require doctors to detail financial and medical information, as well as information about the number and activities of physicians operating in the same market. On the other hand, Federal law would appreciably alter this balance of power, since physicians applying to collectively negotiate would not necessarily be required to comply with these requirements.

For more details, see "Adjusting the balance of power: An analysis of physician antitrust exemption legislation," by Drs. Hellinger and Young, in the July 4, 2001 Journal of the American Medical Association 286(1), pp. 83-88.

Reprints (AHRQ Publication No. 01-R085) are available from the AHRQ Publications Clearinghouse.

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