Regulating managed care plans: is the telecommunications industry a possible model?

Area of Science:

• Health Services Management
• Healthcare Economics
• Health Policy

Background:

• Merger mania has significantly impacted the health and managed care sectors over the past decade.
• Anticipated benefits include improved service integration, reduced excess capacity, enhanced price competition, and better risk-based payment capabilities for providers and insurers.

Purpose of the Study:

• To analyze the ongoing trend of mergers and acquisitions in the healthcare industry.
• To propose a potential regulatory model for future healthcare system organization and financing.

Main Methods:

• Argumentative analysis of healthcare market trends.
• Comparative policy analysis, referencing the Telecommunications Act of 1996 and Ameriplan (1970).

Main Results:

• Strong, well-financed managed care plans and health networks will likely continue mergers to gain regional control over healthcare organization and financing.
• The quasi-competitive, quasi-regulatory framework of the Telecommunications Act of 1996 presents a potential model for federal/state governmental interrelationships in managed care.

Conclusions:

• Continued consolidation through mergers is expected to increase the market control of large healthcare entities.
• Legislative bodies may consider adapting telecommunications regulatory models for future healthcare policy design.