医疗保险市场中保险人与服务提供者之间的反竞争合同

中文摘要

对于美国拥有私人健康保险的人群而言, 保险方与医疗服务提供方之间的合同对于促进医疗竞争和提高效率十分重要。然而, 保险方—提供方的合同条款并不总是促进竞争和消费者福利。本文讨论保险方用于增强竞争的缔约策略, 以及四类反竞争合同条款: 反分层或反引导、全有或全无、最惠国以及禁言条款——占主导地位的医疗系统可能利用这些条款保护自身免受竞争。最后, 我讨论可用于应对提供方使用反竞争条款的政策回应, 以及可降低提供方市场势力负面影响的政策回应。理解反竞争合同条款以及限制其影响的潜在政策回应, 对于医疗竞争至关重要。

Abstract

For people with private health insurance in the United States, contracts between insurers and providers are important to fostering health care competition and improving efficiency. However, insurer-provider contract provisions do not always advance competition and consumer welfare. This essay discusses the contracting strategies used by insurers to increase competition, and four anticompetitive contract terms: anti-tiering or anti-steering, all-or-nothing, most favored nation, and gag clauses, that may be used by dominant health systems to protect themselves from competition. I conclude with a discussion of policy responses that can be used to address provider use of anticompetitive clauses and that can reduce the negative impacts of provider market power. Understanding anticompetitive contract provisions and the potential policy responses to limit their impact is critical to health care competition.