Antitrust and Market Competition
Playing Favorites — State Protection of Academic Medical Centers from Antitrust Oversight
New England Journal of Medicine
Jaime S. King, Katherine L. Gudiksen, Anna D. Sinaiko
The authors explore a new trend with U.S. academic medical centers (AMCs) merging with nonacademic hospitals and health care systems. These mergers pose risks of price increases and other competitive harms. Regulators should review all transactions involving an AMC and ensure that any promised benefits from consolidation do not harm the public. Notably, at least four states have laws explicitly protecting their state-university AMCs from some form of antitrust oversight, or have considered passing such legislation. New Mexico exempts state university hospitals from certain transaction reviews, while North Carolina considered—but rejected—granting UNC Health broad antitrust immunity. California's constitutional structure gives its university health system significant autonomy, creating uncertainty around oversight, and Oregon allows its state university system to pursue acquisitions that could be shielded from antitrust scrutiny, though newer review processes provide some checks. The authors conclude that it would be unwise to exempt state-university AMCs from antitrust oversight to facilitate their growth or as a form of protection.
Competition in Health Insurance Markets
National Bureau of Economic Research
Martin Gaynor and Amanda Starc
Here, the authors seek to identify why the U.S. insurance market is becoming more concentrated over time. They explain that most Americans rely on private insurance, yet these markets are highly concentrated and increasingly dominated by a small number of firms. One reason is structural: larger insurers benefit from economies of scale, reduced risk through larger enrollee pools, and stronger bargaining power with providers, making it difficult for smaller firms to compete. Rising fixed costs, especially for technology and administration, further advantage large insurers and discourage new entrants. Consolidation is also driven by mergers and acquisitions, which increase market power and reduce competition. The authors argue that this concentration can harm consumers by raising premiums and limiting coverage options as competitive pressures weaken. They also emphasize that information problems, like adverse selection, distort competition and can even push markets toward monopoly. Overall, the authors conclude that without effective regulation and oversight, increasing concentration will continue to undermine the performance of U.S. health insurance markets.
To Make Health Care Price Transparency Work, Prioritize Actionable Disclosure And Competition Guardrails
Health Affairs
Chuanzi Yue and Marisa Miraldo
The authors argue that to be effective, transparency in the U.S. must be paired with steerage and competition guardrails. They note that transparency can affect equilibrium prices in three ways: by making it easier for patients to compare prices, by allowing health care providers to see other providers' prices promptly, and by changing insurer-provider bargaining. Firstly, the authors examine mixed evidence on transparency as a cost-reduction tool. Some evidence shows that transparency can lower negotiated prices when information is actionable; however, other international data suggests otherwise, as patients who are informed of service prices may opt for increased use of tests or imaging. The authors then examine collusion and market consolidation, explaining that in concentrated healthcare markets, price transparency can make it easier for competitors to monitor one another and coordinate prices. In contrast, limited competition, hospital mergers, and vertical integration further reduce patient choice and weaken incentives to keep prices low. Continuing, the authors examine information spillover under dynamic bargaining, price convergence, and transparency for savings, and conclude that both the federal government and the states should look beyond just expanding disclosure to elevate competition guardrails.
Miscellaneous
Challenges To Anti-Competitive Hospital Contracting Practices: The New York And Presbyterian Hospital
Health Affairs
Isaac Kabrick and Katie Keith
There is a new focus on anticompetitive contracting practices as policymakers look to remedy rising health care costs. Recently, two labor unions sued The New York and Presbyterian Hospital (NYP), alleging that NYP uses its market power to impose anticompetitive contract terms on insurers and employers. A third labor union also urged the Department of Justice to investigate NYP, and the DOJ reportedly opened an investigation in 2025. The lawsuits in New York are among many across the country regarding the use of anticompetitive practices by large hospitals seeking to restrict competition. The authors give background on anticompetitive hospital contracting and the various state and federal actions taken to combat rising prices. They note that these lawsuits have helped highlight how anticompetitive provider contracting practices keep health care costs high, and while they may not be resolved soon, they are exposing these practices and promoting greater transparency and competition to help reduce costs.
Private Equity’s Transformation of American Medicine — Implications for Health Equity
New England Journal of Medicine
Ruqaiijah Yearby and Marcella Alsan
The authors are exploring the implications of private equity (PE) firms on health equity. They argue that robust regulation and enforcement are needed to ensure that PE growth does not harm patients. In the early 2000s, the U.S. sought to improve health equity, but healthcare became increasingly corporatized, with PE investment growing from $5 billion to $100 billion between 2000 and 2018. Regulatory failures, profit-focused incentives, and favorable economic conditions, such as low interest rates and increased demand for health services, drove this surge. Ongoing financial strain on health systems, including Medicaid cuts, continues to create opportunities for PE expansion despite limited focus on patient outcomes. The authors examine two case studies that demonstrate how private equity practices can destabilize health systems while prioritizing investor returns. In the Nix Health Care System, strategies like sale–leasebacks, heavy debt loading, and executive payouts led to financial decline, worsening care quality, and eventual hospital closures. A similar pattern occurred in Pennsylvania's Crozer Health System, where hospitals shut down despite public financial support after significant profits had already been extracted. They note that there are additional measures that could be considered to limit harmful PE accounting and operational practice, such as state laws penalizing PE firms for harmful practices, utilizing federal False Claims Act and analogous state laws to prohibit fraudulent statements to government, holding PE fund managers and executives personally liable for practices that result in harm, and more. The authors acknowledge that PE has extended financing to under-resourced health care systems; however, they conclude that PE has only done so at the expense of many marginalized communities.
A Crucial Step Toward Site-Neutral Payment: National Provider Identifier Reform
Health Affairs Forefront
Jared Perkins, Roslyn Murray, Christopher M. Whaley, Erin C. Fuse Brown
The authors note that a recent federal policy change requiring hospital off-campus sites to have a distinct National Provider Identifier for billing purposes is a major step toward site-neutral payment, in which services are billed based on what is performed, not where the service is delivered. The article states that increased transparency should curb billing practices that mask the true location of care and create distortions in healthcare spending, leading payers to often overpay for care based on site designation. Ideally, this should help remove an incentive for system consolidation, reducing prices while encouraging competitive equity.
Leave A Comment