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October 17, 2001

Economic Consequences of Collective Bargaining by Physicians—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorJody W.ZylkeMD, Contributing EditorIndividualAuthor

JAMA. 2001;286(15):1837-1839. doi:10.1001/jama.286.15.1833

In Reply: Dr Birnbaum clarifies some of the issues we sought to raise in our article. He states that HMOs form relationships with many types of providers other than physicians and the negotiating strength of those providers also ultimately influences HMO premiums. While it is generally assumed that greater negotiating leverage on the part of providers will translate into higher prices for consumers, whether and to what degree such price hikes would occur depends on various market dynamics such as the negotiating position of employers vis-a-vis HMOs. We certainly agree with Birnbaum that more research is needed to understand how a shift in the balance of power to providers generally and physicians specifically will affect HMO premiums. The CBO assumption concerning how much physician fees account for health plan costs, is actually one of several possibly questionable assumptions that CBO had to make in estimating the impact of physician antitrust waivers on health care costs. Any effort to estimate the impact of antitrust waivers is particularly limited by the dearth of research on physician market concentration and physician prices.