Health Care

Health Care Mergers

NERA's health economists have been retained to evaluate the likely competitive effects of a variety of proposed mergers and acquisitions in the health care field such as hospitals and health insurers. Over the past several years, NERA has analyzed over 75 hospital mergers and provided strategic advice on choosing merger partners in many more.

NERA has also been called upon to assess the competitive effects of mergers of medical equipment manufacturers, pharmaceutical companies, home health care companies, physician practice management companies, manufacturers of clinical diagnostic tests, and ambulance services.
In addition to these horizontal mergers, NERA has worked on mergers that raise concerns about vertical foreclosure. These would include transactions involving insurers and hospitals as well as mergers in the medical equipment industry. We also have written reports and provided advice and testimony on a wide range of cases.

In merger reviews, we have:

• Analyzed horizontal mergers involving freestanding hospitals, acquisitions involving hospital chains, the formation of hospital networks, joint ventures, joint operating agreements, and strategic alliances;
• Frequently presented the results of our analyses to staff attorneys and economists at the Federal Trade Commission, the Department of Justice, state attorneys general, and state departments of insurance;
• Written reports that assess the likely efficiencies associated with horizontal integration and with vertical integration between health insurers, hospitals, and physician groups;
• Advised state agencies on the types of hospital mergers that are permitted under certificate of public advantage legislation and on the type of monitoring and regulation that would be required post-merger;
• Assisted in the defense of a hospital accused of monopoly overcharges by demonstrating that its pricing structure and price increases over time have been well within the mainstream of comparable hospitals;
• Testified on behalf of hospitals in antitrust litigation involving staff privileges or exclusive contracting issues for anesthesia, neonatology, vascular surgery, cardiac surgery, obstetrics, radiology, and cardiology specialists;
• Written numerous papers on hospital antitrust issues including merger efficiencies, geographic markets, and hospital merger policy;
• Analyzed product market issues and the competitive effects of many affiliations between major health insurers;
• Analyzed the competitive effects of alleged physician boycotts against major health insurers;
• Analyzed the potential for exclusive provider contracts and most-favored nations provider contracts with a health insurer to facilitate monopolization by the insurer;
• Analyzed patient migration patterns to determine whether a Catholic hospital's religious directives caused problems with access to women's reproductive services following a merger; and
• Analyzed the competitive effects of joint ventures among hospitals to sell a broad geographic network product to statewide and regional insurers.