Is Bigger Better? Legal and Policy Issues in Health Plan Mergers: A Guide for State Health Policy Makers
In the spring of 1998, two health plans, Humane and United Healthcare, proposed to merge. The $6.2 billion transaction, the largest in a growing number of health plan mergers over the last decade, would have created one of the nation’s biggest health plans covering 10 million people.1 Because one or both plans operated in virtually every state, the merger would have affected many local health care markets throughout the U.S.2 Federal and state antitrust and insurance officials were beginning to evaluate the merger’s effects on market competition, when (due in part to United’s declining profits and stock price) the deal was unexpectedly canceled in early August. But the proposal served to alert regulators in many states of the need to assess the effects on competition of health plan merger.
For over two decades, the state and federal governments have encouraged the development of health care delivery and financing arrangements, such as health maintenance organizations (HMOs), to control costs and improve quality. Yet as managed care plans have become large and powerfial, through mergers, state policy makers increasingly face the need to review their potential impact on local market competition. This monograph is designed to help state policy makers understand the legal and policy issues, primarily under the antitrust laws, that may be raised when health plans merge3 and the tools available to review the competitive advantages and disadvantages of these transactions. By focusing on health plan mergers, this report expands upon an earlier National Academy for State Health Policy monograph on state antitrust policy regarding health care provider activities.‘ Because the product provided by health plans includes features of insurance as well as the delivery of health services, health plan mergers raise issues beyond those presented when, for example, health care providers develop non-risk-bearing integrated networks.
| 1998.Dec_.legal_.policy.issues.health.plan_.mergers.guide_.pdf | 1.6 MB |
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
