Stavroulaki: The Healing Power of Antitrust
In The Healing Power of Antitrust, Theodosia Stavroulaki (Saint Louis University School of Law) analyzes the effects of noncompete and merger agreements between rural hospitals, which lead to “hospital deserts,” geographic areas lacking access to hospitals and primary care physicians. These areas leave millions of Americans without necessary medical care, further exacerbating health and racial disparities that leave rural populations particularly vulnerable.
Rural hospital closures have accelerated in recent years, leaving many rural populations without care. Stavroulaki explains that rural hospitals are especially economically vulnerable compared to their urban counterparts for many reasons, including lower patient volume and a high percentage of patients covered by Medicaid as opposed to private insurance. Rural hospitals also struggle due to labor shortages. Nurses and physicians in rural communities are much less prevalent and frequently experience burnout, lower wages, and limited employment options.
While several policies have sought to remedy the issues in rural healthcare, such as Medicaid expansion and telemedicine, Stavroulaki argues that the cause of these challenges lies elsewhere—in anticompetitive behaviors by rural providers. Mergers between providers in the healthcare industry have accelerated since the 1990s, and rural areas are no exception. Additionally, hospitals increasingly use highly restrictive noncompete agreements to prevent nurses and physicians from practicing in the same area after leaving their employment. Stravroulaki argues that both of these strategies have exacerbated the hospital desert issue in rural communities, as mergers accelerate hospital shutdowns while noncompete agreements contribute to a dwindling number of available staff due to the need for staff to relocate to find alternative work.
To combat these anticompetitive activities, Stavroulaki proposes three policy changes. First, Stavroulaki argues that courts should find noncompete agreements in the healthcare sector to constitute per se violations of the Sherman Act, the primary statute for antitrust enforcement. Second, Stavroulaki calls for increased assessment of the impact of hospital mergers on wages and working conditions by antitrust enforcers. Lastly, Stavroulaki contends that antitrust enforcers should only accept hospital mergers in rural areas when the acquiring hospital agrees not to shut down the hospital it acquires nor cut its healthcare services to rural residents. Stavroulaki asserts that the implementation of such policies could help mitigate the health and racial disparities facing rural America.
