Antitrust Issues in the Joint Purchasing of Health Care

Current developments on the health care scene are calling new attention to antitrust questions that arise when multiple actors combine to purchase goods or services. Although employers have collaborated for mutual assistance in the procurement of health care for their employees since the 1970s, local employer coalitions are becoming increasingly interested in bargaining collectively for the purchase of health coverage or health services. The 1990s have also seen a movement to create "purchasing cooperatives" to procure or bargain for health coverage on behalf of small businesses and individuals; several states have provided for such cooperatives in legislation. Furthermore, recent reform proposals at the federal level contemplated the creation of new intermediaries to "manage" competition among health plans4 either for the benefit of all but the largest purchasers or only for small employers and self-employed individuals; although managed competition does not necessarily entail joint purchasing, some versions of the strategy visualize a manager that would bargain aggressively with individual health plans over price.

Actual joint purchasing can itself take several forms. Used wisely, it can improve the ability of purchasers to secure good health coverage at affordable rates.