Health System Reform and Antitrust Law

The Antitrust Aspects of Health Information Sharing by Public and Private Health Insurers

Antitrust law rests on the philosophy that the economy functions best when markets thrive and when purchasers, armed with information, are able to make decisions that yield both quality and value. Thus, the overarching aim of antitrust law is to advance free and open markets in which competition can flourish. Even though medical care itself represents the single largest part of the economy, it is different from buying televisions, and how to adapt health care buying and selling to the law of markets has proven to be a complex undertaking.

This policy brief addresses antitrust considerations that arise in health system transformation aimed at producing greater clinical integration and greater levels of information about the quality and cost of care. It focuses on those activities that can be pursued without running afoul of basic antitrust principles and also describes types of conduct that appear to venture into prohibited-conduct territory in four case scenarios.