scholarly journals Inadequate in the Best of Times: Reevaluating Provider Networks in Light of the Coronavirus Pandemic

2020 ◽  
Vol 12 (3) ◽  
pp. 282-290 ◽  
Author(s):  
Simon F. Haeder
Keyword(s):  
Provider Networks

Implementing the Affordable Care Act: State Regulation of Marketplace Plan Provider Networks

2015 ◽  
Author(s):  
Sabrina Corlette Corlette ◽  
Kevin W. Lucia Lucia ◽  
Justin Giovannelli Giovannelli
Keyword(s):  
Affordable Care Act ◽  
State Regulation ◽  
Provider Networks ◽  
The Affordable Care Act

scholarly journals Equilibrium Provider Networks: Bargaining and Exclusion in Health Care Markets

2019 ◽  
Vol 109 (2) ◽  
pp. 473-522 ◽  
Author(s):  
Kate Ho ◽  
Robin S. Lee
Keyword(s):  
Health Care ◽  
Consumer Welfare ◽  
Bargaining Solution ◽  
Health Care Markets ◽  
Social Incentives ◽  
Provider Networks ◽  
Hospital Networks ◽  
Private Incentives ◽  
Social Surplus ◽  
Optimal Networks

We evaluate the consequences of narrow hospital networks in commercial health care markets. We develop a bargaining solution, “Nash-in-Nash with Threat of Replacement,” that captures insurers’ incentives to exclude, and combine it with California data and estimates from Ho and Lee (2017) to simulate equilibrium outcomes under social, consumer, and insurer-optimal networks. Private incentives to exclude generally exceed social incentives, as the insurer benefits from substantially lower negotiated hospital rates. Regulation prohibiting exclusion increases prices and premiums and lowers consumer welfare without significantly affecting social surplus. However, regulation may prevent harm to consumers living close to excluded hospitals. (JEL C78, D85, G22, H75, I11, I13, I18)

scholarly journals Traffic Engineering through MPLS in Service Provider Networks

2013 ◽  
Vol 72 (11) ◽  
pp. 1-6
Author(s):  
Y RamaDevi ◽  
B. Ramadasu ◽  
B. H. Raj Gopal
Keyword(s):  
Service Provider ◽  
Traffic Engineering ◽  
Provider Networks

Risky Business: Proposed Reform of the Antitrust Laws As Applied to Health Care Provider Networks

1998 ◽  
Vol 24 (1) ◽  
pp. 59-87
Author(s):  
Natalie Marjancik
Keyword(s):  
Health Care ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Health Care Services ◽  
Care Delivery ◽  
Antitrust Enforcement ◽  
Care Providers ◽  
Antitrust Laws ◽  
Provider Networks

Because the health care industry comprises over thirteen percent of the American economy, law enforcers increasingly apply antitrust law to all aspects of health care delivery and financing. Through antitrust enforcement, consumers receive the benefits of lower health care costs and improved health care services. To achieve further cost savings, health care providers are forming, as well as joining, many different types of provider network joint ventures. Providers form networks, expect ing “them to generate efficiencies, reduce excess capacity, improve utilization, permit greater specialization and enhance quality.” However, because they organize competing physicians and enable them to collaborate on prices and set fee schedules, provider networks raise serious antitrust concerns. Consequently, the federal government and courts are increasingly focusing their antitrust enforcement efforts on the formation and anticompetitive activities of provider networks.In Part I, this Note addresses the degree to which network providers must be economically and financially integrated to legally collaborate and set prices. Part II briefly explains the procedures one may use to enforce the federal antitrust laws. Following this explanation of antitrust enforcement procedures, Part III discusses the relevant statutory and case law applicable to health care provider networks.

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