Posted by Social Science Research Network
Hospital Mergers and Economic Efficiency
Roger D. Blair (University of Florida), Christine Durrance (University of North Carolina) & D. Daniel Sokol (University of Florida)
Abstract: Consolidation via merger both from hospital-to-hospital mergers and from hospital acquisitions of physician groups is changing the competitive landscape of the provision of health care delivery in the United States. This Article undertakes a legal and economic examination of a recent Ninth Circuit case examining the hospital acquisition of a physician group. This Article explores the Saint Alphonsus Medical Center-Nampa Inc. v. St. Luke’s Health System, Ltd. (St. Luke’s) decision — proposing a type of analysis that the district court and Ninth Circuit should have undertaken and that we hope future courts undertake when analyzing mergers in the health care sector. First, the Article addresses the question of how best to frame the acquisition of a physician group by a hospital — is the merger horizontal, vertical, or potentially both? In undertaking this analysis the Article examines the broader issue of the treatment of Accountable Care Organizations (ACOs) in antitrust law. ACOs are short of full integration and as such, a potential contractual alternative for hospitals and physician groups to an acquisition. A hospital acquisition of a physician practice also has implications for how to view competitive effects in the context of ACOs. Indeed, in St. Luke’s the Ninth Circuit suggests that integration short of full merger was a possible alternative. Second, the Article examines the justification for integration as a way to address countervailing power in health care, the reduction of transaction costs, and potential cost and quality efficiencies. Third, the Article applies the economics of these issues to merger case law generally and specifically to the St. Luke’s decision. Ultimately, the Article finds the economic analysis of the Ninth Circuit lacking. Finally, the Article offers policy implications of the decision and concludes with some suggestions to improve health care antitrust analysis in practice for litigated cases to make such analysis better follow economic principles.
Featured News
On Witness Stand, Google CEO Challenges DOJ’s Proposed Remedies In Search Monopoly Case
Apr 30, 2025 by
CPI
Latham & Watkins Expands German Antitrust Practice
Apr 30, 2025 by
CPI
DoorDash, Grubhub, and Uber Eats Settle With NYC Over Cap Fees
Apr 30, 2025 by
CPI
Pork Giants Push to Overturn Price-Fixing Suit Citing Clerk’s Alleged Conflicts
Apr 30, 2025 by
CPI
Novartis to Acquire Regulus Therapeutics in $1.7 Billion Deal
Apr 30, 2025 by
CPI
Antitrust Mix by CPI
Antitrust Chronicle® – Mergers in Digital Markets
Apr 21, 2025 by
CPI
Catching a Killer? Six “Genetic Markers” to Assess Nascent Competitor Acquisitions
Apr 21, 2025 by
John Taladay & Christine Ryu-Naya
Digital Decoded: Is There More Scope for Digital Mergers In 2025?
Apr 21, 2025 by
Colin Raftery, Michele Davis, Sarah Jensen & Martin Dickson
AI In the Mix – An Ever-Evolving Approach to Jurisdiction Over Digital Mergers in Europe
Apr 21, 2025 by
Ingrid Vandenborre & Ketevan Zukakishvili
Antitrust Enforcement Errors Due to a Failure to Understand Organizational Capabilities and Dynamic Competition
Apr 21, 2025 by
Magdalena Kuyterink & David J. Teece