Chapter 9.D.3: Antitrust Merger Law

Discussing the effects of mergers and consolidation in health care, see, e.g., U.S. Departments of Health and Human Services, Treasury and Labor, Reforming America’s Healthcare System Through Choice and Competition (2018); Symposium, Coping with Health Care Market Concentration, 11 J. Health L. & Pol’y 1 (2017); Leemore S. Dafny, Evaluating the Impact of Health Insurance Industry Consolidation (Commonwealth Fund, Nov. 2015); Richard Scheffler & Daniel Arnold, Insurer Market Power Lowers Prices in Numerous Concentrated Provider Markets, 36 Health Aff. 1539 (2017); Kate Ho & Robin S. Lee, Insurer Competition in Health Care Markets, 85 Econometrica 379 (2017); Symposium, Coping with Health Care Market Concentration, 11 St. Louis U. J. Health L. & Pol’y 1-160 (2017); Christopher C. Colenda & William B Applegate. “Gluing together a fragmented healthcare system.” 72 J. Am. Geriatrics Soc’y 393 (2024); Rachel M Machta, et al. “A systematic review of vertical integration and quality of care, efficiency, and patient-centered outcomes.” 44 Health Care Management Rev. 159 (2019); Erin Fuse Brown, Jaime King & David Cutler, Hospitals, Market Share, and Consolidation, 310 JAMA 1964 (2013); Jeff Goldsmith et al., Integrated Delivery Networks: In Search of Benefits and Market Effects (NASI, Feb. 2015); David Dranove & Andrew Sfekas, The Revolution in Health Care Antitrust: New Methods and Provocative Implications, 87 Milbank Q. 607 (2009); Kristin Madison, Hospital Mergers in an Era of Quality Improvement, 7 Hous. J. Health L. & Pol’y 265 (2007); Note, 90 B.U. L. Rev. 431 (2010); Symposium, 36 Health Aff. 1527 (2017).

Discussing cross-market or vertical mergers, see Jaime King, et al., Antitrust's Healthcare Conundrum: Cross-Market Mergers and the Rise of System Power, 74 Hastings L.J. 1057-1120 (2023); Jaime King & Erin Fuse Brown, The Anti-Competitive Potential of Cross-Market Mergers in Health Care, 11 J. Health L. & Pol’y 1 (2017); Thomas L. Greaney, The New Health Care Merger Wave: Does the “Vertical, Good” Maxim Apply?, 46 J. L. Med. Ethics 918 (2018); Thomas L. Greaney, Michael J. Perry & Matthew B. Adler, Antitrust Enforcement Policy for Cross-Market Health Care Mergers: Legal Theories, Limiting Principles, and Practical Considerations. 83 Antitrust L.J. 483-508 (2020); Emilio Varanini, Addressing the Red Queen Problem: A Proposal for Pursuing Antitrust Challenges to Cross-Market Mergers in Health Care Systems. 83 Antitrust L.J. 509-526 (2020); Gregory S. Vistnes & Yianis Sarafidis, Cross-Market Hospital Mergers: A Holistic Approach, 79 ANTITRUST L.J. 253, 255-57, 260-63 (2013).

On the government’s track record in court, see Barak D. Richman, Antitrust and Nonprofit Hospital Mergers: A Return to Basics, 156 U. Pa. L. Rev. 121 (2007); Thomas L. Greaney, Thirty Years of Solicitude: Antitrust Law and Physician Cartels, 7 Hous. J. Health L. & Pol’y (2007); Jennifer R. Conners, A Critical Misdiagnosis: How Courts Underestimate the Anticompetitive Implications of Hospital Mergers, 91 Cal. L. Rev. 543 (2003); Casenote, 130 Harv. L. Rev. 1736 (2017).

For analysis of the legal issues in the St. Luke’s case, see T. Greaney & D. Ross, Navigating Through the Fog of Vertical Merger Law, 91 Wash. L. Rev. 191 (2016); Roger Blair et al., Hospital Mergers and Economic Efficiency, 91 Wash. L. Rev. 1 (2016). 

Addressing how states could take a more prominent enforcement or oversight role, see Erin Fuse Brown & Jaime King, The Double-Edged Sword of Health Care Integration: Consolidation and Cost Control, 92 Ind. L. J. 55 (2016).

On antitrust analysis for nonprofit hospitals, see Barak D. Richman, The Corrosive Combination of Nonprofit Monopolies and U.S.-Style Health Insurance: Implications for Antitrust and Merger Policy, 69 Law & Contemp. Probs. 139 (Autumn 2006); Clark Havighurst & Barak Richman, The Provider Monopoly Problem in Health Care, 89 Or. L. Rev. 847 (2011).

Regarding the efficiencies defense, see Gibson, Matthew G. Note. Exceptional Efficiencies: A Valuable Defense for Healthcare Mergers. 122 Colum. L. Rev. 1957-1996 (2022)