An introduction to the justice in the health care system in the united states

What Societies Do About Access to Care We might seek guidance from how some societies assure access to care, keeping in mind that what societies actually do may not coincide with what they should do as a matter of justice. If, however, there is widespread belief that people owe each other access to certain kinds of care, and this belief is embodied in institutions that attempt to do that, it may give us some evidence about what people think they owe each other. Of course, we find different institutional provisions of access in different settings, and the differences may not reflect differences in belief as much as differences in resources or social history. Nearly all developed countries provide all their residents with access to a broad set of public health and individual medical interventions.

An introduction to the justice in the health care system in the united states

This statement of enforcement policy sets forth an antitrust safety zone that describes hospital high-technology or other expensive health care equipment joint ventures that will not be challenged, absent extraordinary circumstances, by the Agencies under the antitrust laws.

It then describes the Agencies' antitrust analysis of hospital high-technology or other expensive health care equipment joint ventures that fall outside the antitrust safety zone. Finally, this statement includes examples of its application to hospital high-technology or other expensive health care equipment joint ventures.

Hospital High-Technology Joint Ventures That Will Not Be Challenged, Absent Extraordinary Circumstances, By The Agencies The Agencies will not challenge under the antitrust laws any joint venture among hospitals to purchase or otherwise share the ownership cost of, operate, and market the related services of, high-technology or other expensive health care equipment if the joint venture includes only the number of hospitals whose participation is needed to support the equipment, absent extraordinary circumstances.

For example, if two hospitals are each unlikely to recover the cost of individually purchasing, operating, and marketing the services of a magnetic resonance imager MRI over its useful life, their joint venture with respect to the MRI would not be challenged by the Agencies.

On the other hand, if the same two hospitals entered into a joint venture with a third hospital that independently could have purchased, operated, and marketed an MRI in a financially viable manner, the joint venture would not be in this antitrust safety zone. If, however, none of the three hospitals could have supported an MRI by itself, the Agencies would not challenge the joint venture.

This information may include the cost of the equipment, its expected useful life, the minimum number of procedures that must be done to meet a machine's financial breakeven point, the expected number of procedures the equipment will be used for given the population served by the joint venture and the expected price to be charged for the use of the equipment.

Expected prices and costs should be confirmed by objective evidence, such as experiences in similar markets for similar technologies. The Agencies will apply a rule of reason analysis in their antitrust review of such joint ventures.

This analysis is flexible and takes into account the nature and effect of the joint venture, the characteristics of the venture and of the hospital industry generally, and the reasons for, and purposes of, the venture. It also allows for consideration of efficiencies that will result from the venture.

The steps involved in a rule of reason analysis are set forth below. Define the relevant market. The rule of reason analysis first identifies what is produced through the joint venture.

The relevant product and geographic markets are then properly defined.

An introduction to the justice in the health care system in the united states

This process seeks to identify any other provider that could offer what patients or physicians generally would consider a good substitute for that provided by the joint venture. Thus, if a joint venture were to purchase and jointly operate and market the related services of an MRI, the relevant market would include all other MRIs in the area that are reasonable alternatives for the same patients, but would not include providers with only traditional X-ray equipment.

Evaluate the competitive effects of the venture. This step begins with an analysis of the structure of the relevant market. If many providers would compete with the joint venture, competitive harm is unlikely and the analysis would continue with step four described below.

If the structural analysis of the relevant market showed that the joint venture would eliminate an existing or potentially viable competing provider and that there were few competing providers of that service, or that cooperation in the joint venture market may spill over into a market in which the parties to the joint venture are competitors, it then would be necessary to assess the extent of the potential anticompetitive effects of the joint venture.

In addition to the number and size of competing providers, factors that could restrain the ability of the joint venture to raise prices either unilaterally or through collusive agreements with other providers would include: The extent to which the joint venture restricts competition among the hospitals participating in the venture is evaluated during this step.

In some cases, a joint venture to purchase or otherwise share the cost of high-technology equipment may not substantially eliminate competition among the hospitals in providing the related service made possible by the equipment.timberdesignmag.com means it’s official.

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