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Physician Collective Bargaining
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Symposium: ABJS Carl T. Brighton Workshop on Health Policy Issues in Orthopaedic Surgery
Physician Collective Bargaining
Anthony Hunter Schiff1, 2, 3 
| (1) |
1875 Century Park East, Suite 1600, Los Angeles, CA 90067, USA |
| (2) |
UCLA School of Public Health, Los Angeles, CA, USA |
| (3) |
Schiff & Bernstein, APC, Los Angeles, CA, USA |
Received: 18 December 2008 Accepted: 13 July 2009 Published online: 12 September 2009
Abstract Current antitrust enforcement policy unduly restricts physician collaboration, especially among small physician practices.
Among other matters, current enforcement policy has hindered the ability of physicians to implement efficient healthcare delivery
innovations, such as the acquisition and implementation of health information technology (HIT). Furthermore, the Federal Trade
Commission and Department of Justice have unevenly enforced the antitrust laws, thereby fostering an increasingly severe imbalance
in the healthcare market in which dominant health insurers enjoy the benefit of largely unfettered consolidation at the cost
of both consumers and providers. This article traces the history of antitrust enforcement in healthcare, describe the current
marketplace, and suggest the problems that must be addressed to restore balance to the healthcare market and help to ensure
an innovative and efficient healthcare system capable of meeting the demands of the 21st century. Specifically, the writer
explains how innovative physician collaborations have been improperly stifled by the policies of the federal antitrust enforcement
agencies, and recommend that these policies be relaxed to permit physicians more latitude to bargain collectively with health
insurers in conjunction with procompetitive clinical integration efforts. The article also explains how the unbridled consolidation
of the health insurance industry has resulted in higher premiums to consumers and lower compensation to physicians, and recommends
that further consolidation be prohibited. Finally, the writer discusses how health insurers with market power are improperly
undermining the physician-patient relationship, and recommend federal antitrust enforcement agencies take appropriate steps
to protect patients and their physicians from this anticompetitive conduct. The article also suggests such steps will require
changes in three areas: (1) health insurers must be prohibited from engaging in anticompetitive activity; (2) the continuing
improper consolidation of the health insurance industry must be curtailed; and (3) the physician community must be permitted
to undertake the collaborative activity necessary for the establishment of a transparent, coordinated, and efficient delivery
system.
Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest,
patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.
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