A competitive analysis of most favored nations clauses in contracts between health care providers and insurers.

Competition between health maintenance organizations and nonintegrated health insurance companies in health insurance markets

This article examines a model of competition between two types of health insurer: Health Maintenance Organizations (HMOs) and nonintegrated insurers. HMOs vertically integrate health care providers and pay them at a competitive price, while nonintegrated health insurers work as indemnity plans and pay the health care providers freely chosen by policyholders at a wholesale price. Such difference...

Hospital Choice for Cataract Treatments: The Winner Takes Most

Background Transparency in quality of care is an increasingly important issue in healthcare. In many international healthcare systems, transparency in quality is crucial for health insurers when purchasing care on behalf of their consumers, for providers to improve the quality of care (if necessary), and for consumers to choose their provider in case treatment is needed. Conscious consume...

Potential anticompetitive effects of most favored nation contract clauses in managed care and health insurance contracts.

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 f...

Optimisation of Healthcare Contracts: Tensions Between Standardisation and Innovation; Comment on “Competition in Healthcare: Good, Bad or Ugly?”

An important determinant of health system performance is contracting. Providers often respond to financial incentives, despite the ethical underpinnings of medicine, and payers can craft contracts to influence performance. Yet contracting is highly imperfect in both single-payer and multi-payer health systems. Arguably, in a competitive, multi-payer environment, contractual innovation may occur...