FTC gives OK to study insurance market

But Ohio physicians can't use the survey information to fix prices, the commission warns.

By Tanya Albert, AMNews staff. March 3, 2003.

In the coming months, Dayton, Ohio, physicians and patients will determine whether health plan reimbursement rates and other practices affect health care quality in the region and if so, how. And the study could open the door for physicians in other metropolitan areas to evaluate their markets, too.

The Federal Trade Commission in February issued an advisory opinion that allows Dayton physicians -- without fear of breaking antitrust laws -- to start gathering data from individual doctors so that they can evaluate how specific health insurance companies are performing in the community.

The FTC also gave the physicians the go-ahead to educate the public about their findings.

"We feel this will validate our concerns about how health care has been affected," said Dayton family physician Mark A. Couch, MD, president of PriMed Physicians, the medical group that asked the FTC for an opinion.

Dr. Couch said he had referred patients to specialists in Cleveland, a drive of three hours or more, because there aren't enough specialists in Dayton. Doctors in Dayton also say they are having a hard time recruiting new physicians because health plan reimbursement rates are low.

Doctors believe a heavily concentrated HMO and PPO market is to blame. United HealthCare has 63% of market share in the Dayton-Springfield area, and Anthem BlueCross BlueShield has 27% of the market, said the American Medical Association's 2002 study "Competition in Health Insurance: A Comprehensive Study of U.S. Markets." The Dayton figures reflect one of the highest combined market shares in the nation, the study found.