The Federal Trade Commission (FTC) has an important role to play in promoting competition within healthcare, two blog posts from Health Affairs argue.
In the first post, Julie Brill, an FTC commissioner since 2010, cites a series of court losses the agency suffered in the mid-to-late 1990s involving hospital merger challenges. In 2002, she writes, the FTC conducted a study to determine the reasons for the losses, which led to research indicating the mergers it unsuccessfully challenged had anticompetitive effects on the market, such as higher prices. Furthermore, Brill writes, court reliance on erroneous economic analyses was a major contributing factor in the FTC's losses.
This analysis, she writes, helped the agency reform its enforcement framework to reflect healthcare's merger activity's specific competitive dynamics. Last spring, the 6th Circuit Court of Appeals upheld the FTC's ruling that a proposed merger between ProMedica Health System and Ohio's St. Luke's Hospital would be anti-competitive, the first time an appeals court ruled on the FTC blocking a merger since the agency's reforms, Brill writes. The ProMedica decision was particularly significant because it derived from a strong correlation between the health systems market share and overall prices, and because it affirmed the FTC's presumption of illegality in a case where the correlation between the two was strong.
Nor is this all the FTC does to advance a competitive healthcare market, FTC Commissioner Maureen Ohlhausen writes in the second post. In addition to its enforcement work, she writes, the agency advocates against attempts at the federal and state levels to create antitrust exemptions for collective negotiations for competing providers, which usually result in increased prices and harm to consumers.
It also advocates easing scope of practice regulations, which she writes can stifle competition from providers who can provide similar care at lower cost, such as advance-practice registered nurses (APRNs). "[O]ur advocacies, consistent with the Institute of Medicine's policy position, have suggested that any limits on APRNs' ability to provide medical services should be no stricter than necessary to protect patient safety," Ollhausen writes.