While lawmakers in 11 states consider antitrust exemptions for physicians this year, very little authoritative research exists to help policymakers assess a key point of contention: cost.
"Unfortunately, there is little research about the potential impact of such legislation on healthcare costs to guide policymakers," said Gary Young, a researcher who co-authored a new study on antitrust exemptions published in the July 3 issue of the Journal of the American Medical Association.
The study by Young, an associate professor of health services at the Boston University School of Public Health, was designed to examine the potential impact of antitrust legislation on the balance of power between physicians and managed-care plans.
Only the passage of such a law on a national level, according to the study, "is likely to increase the power of physicians vis-a-vis managed-care plans."
While doctors argue that they need the clout to bargain collectively in an era of reduced fees and rising costs, officials at large health plans are adamantly opposed to the antitrust exemptions, warning that doctors' fees would rise dramatically.
Last year, when Congress considered, but ultimately rejected, a nationwide antitrust exemption to allow doctors to negotiate collectively with health plans, only two studies were conducted to help gauge the financial impact of the law.
One study, funded by the Health Insurance Association of America, estimated that private health insurance premiums would have increased from 3.6% to 17.7%. A study conducted by the Congressional Budget Office estimated that premiums would have increased by 1.9% if the Quality Healthcare Coalition Act had been enacted.
Young's JAMA study said neither estimate of the impact on national antitrust legislation "is based on empirical evidence about the relevant market."
Congress has not yet considered a similar bill this year.
So far, only two states-Texas and Washington-have implemented such laws under the state action immunity doctrine. Neither law has had any significant impact. In Texas, where the law was passed in June 1999, state officials have received only two applications from physician groups requesting the authority to negotiate collectively.
Eighteen states and the District of Columbia considered antitrust exemptions last year, and such legislation is now wending its way through 11 statehouses, including California's, where the measure was overwhelmingly approved last month by the state Assembly and will be considered next week by the Senate Judiciary Committee.
In the District of Columbia, the congressionally appointed financial control board in February voided an antitrust exemption that was passed last year by a 10-2 vote of the city council, citing estimates that it would have cost the local government as much as $3.2 million a year by 2004.