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Health Aff (Millwood). 2018 Sep;37(9):1417-1424. doi: 10.1377/hlthaff.2018.0418.

The California Competitive Model: How Has It Fared, And What's Next?

Author information

1
Glenn A. Melnick ( gmelnick@usc.edu ) is a professor of health economics and financing and the Blue Cross Chair, both at the University of Southern California (USC), in Los Angeles, and a resident consultant at the RAND Corporation in Santa Monica, California.
2
Katya Fonkych is a research associate at the Center for Health Financing, Policy, and Management, USC, and a senior researcher at the Massachusetts Health Policy Commission, in Boston.
3
Jack Zwanziger is a professor of health policy and administration at the University of Illinois at Chicago.

Abstract

California became very successful in controlling rising health care costs by promoting price competition through market-based, managed care policies. However, recent data reveal that the state has not been able sustain its initial success in controlling growth in hospital prices. Two powerful trends emerged in California that eroded the conditions needed to sustain price competition. To ensure timely access to emergency hospital services, government regulators enacted regulations that had the unintended effect of giving hospitals tremendous leverage when contracting with health plans. Also, antitrust authorities allowed hospitals to consolidate into multihospital systems by adding members that were not direct competitors in local markets. The combined effect of these policies and consolidation trends was a substantial reduction in the competitiveness of provider markets in California, which reduced health plans' ability to leverage competitive provider markets and negotiate lower prices and other benefits for their members. Policy makers can and should act to restore competitive conditions.

KEYWORDS:

Cost of Health Care; Financing Health Care; Health Economics; Managed Care

PMID:
30179549
DOI:
10.1377/hlthaff.2018.0418
[Indexed for MEDLINE]

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