NOTE AND COMMENT: Comment on Kartell v. Blue Shield of Massachusetts, Inc .: An Antitrust Analysis of Blue Shield's Reimbursement Schemes Skip over navigation
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Copyright (c) 1986 Boston University School of Law.
American Journal of Law & Medicine

NOTE AND COMMENT: Comment on Kartell v. Blue Shield of Massachusetts, Inc.: An Antitrust Analysis of Blue Shield's Reimbursement Schemes


11 Am. J. L. and Med. 465


Abby Brown Wayne



Health care cost increases have been recognized as a critical and pressing problem facing the health care industry. One of the most significant causes of this inflationary trend has been the infusion of third-party payor funds into the market, substantially upsetting the competitive forces between the patient-consumer and physician-provider. One solution to the problem, employed by insurers, is gaining acceptance and approval by state legislatures and federal and state courts. This is the movement away from a system where physicians determine the prices for their services to a system where insurers not only determine the amount they will reimburse for services but also place a cap on the amount physicians may receive. This movement includes the now successful entry into the health insurance market of prepaid health plans such as health maintenance organizations, preferred provider organizations, and independent practice associations. These differing types of systems provide consumers with choices regarding the type of insurance arrangement which will satisfy their own particular priorities, such as minimizing the price paid for their total health care expenditures.

In addition to these options, the traditional Blue Cross-Blue Shield reimbursement plan has been playing an even greater role in determining the prices for physician services. Blue Shield provides health insurance to its subscribers by covering physician services on a fee-for-service basis. Blue Shield is not a single nationwide corporation, but rather is separately incorporated in each state. Created through state enabling acts to make low cost health insurance readily available, 1
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