根据《谢尔曼法案》,医疗保健行业中使用的最惠国条款如何不合理地限制贸易。

Journal of law and health Pub Date : 2003-01-01
Beth Ann Wright
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引用次数: 0

摘要

在医疗保健行业中使用时,最惠国待遇条款是一种合同协议,保证医疗保险公司与其市场竞争对手享有相同的最优惠价格。最惠国待遇条款的影响是不必要地提高了消费者的成本,减少了提供者之间的选择,限制了获得保健服务的机会,并阻碍了其他保健服务模式的发展。本文的目的有四个方面。首先,设计一个四象限矩阵来评估《谢尔曼法》第1节规定的最惠国条款的促进竞争和反竞争的目的和效果。第二,推翻最惠国条款有利于医疗保健行业竞争的法理假设,并建议废除这一假设。第三,审查美国司法部在过去十年中对大型保险公司起诉的范式转变,这些保险公司采用了导致美国同意法令的最惠国条款。第四,概述对采用最惠国待遇条款的保险公司提出值得称道的索赔的标志。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
How MFN clauses used in the health care industry unreasonably restrain trade under the Sherman Act.

When used in the health care industry, an MFN clause is a contractual agreement that guarantees a health insurer the same best price as their market competitors. MFN clauses have the effect of unnecessarily raising consumer costs, reducing choice among providers, constraining access to care and preventing the development of alternative health care delivery models. The purpose of this paper is four-fold. First, to design a four-quadrant matrix to evaluate the pro-competitive and anticompetitive purposes and effects of MFN clauses under Section 1 of the Sherman Act. Second, to defeat the jurisprudential presumption that MFN clauses are pro-competitive in the health care industry and to recommend that this presumption be abolished. Third, to examine the U.S. Department of Justice's paradigmatic shift over the last decade toward prosecuting large insurers who employ MFN clauses resulting in U.S. Consent Decrees. Fourth, to outline the indicia of a meritorious claim against an insurer who employs an MFN clause.

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