PHYSICIAN-RUN HEALTH PLANS AND ANTITRUST

As the health care system changes and large managed care entities gain greater control in some markets, proponents of antitrust reform have expressed concern that physicians could lose their autonomy. To respon d to this concern, the American College of Physicians has consistently argued that physicians should be allowed to establish their own healt h plans and networks to provide high-quality and cost-effective care. Moreover, the College has advocated utilization review reform and due process protections to empower physicians in their dealings with insur ers. Under current antitrust law, as interpreted by the federal enforc ement agencies, physicians already have the legal authority to form th eir own health plans and networks, and many state medical societies ar e sponsoring such plans. The law also allows physicians to operate the clinical components of a health plan, regardless of who owns it. More over, physicians can share information about quality, utilization, and , in some circumstances, fees. An examination of federal enforcement a gency actions since the mid-1970s shows that physician networks have r arely been challenged. In light of market developments, however, the C ollege has urged the federal antitrust agencies to analyze the effect of their current enforcement policies on physician activities and adop t a more flexible approach. Further monitoring and analysis of the cha nging health care marketplace are necessary to ensure that physicians are being treated fairly and to determine which factors spur or inhibi t the development of physician-run health plans and networks.