The proposed research will examine a wide range of specific legal and regulatory issues in light of recently increased reliance on competition as a force for guiding the health care industry's performance and development. Particular emphasis will be placed on decentralization of decision making as a way of fostering desirable change. Research and writing will focus on specific topics under four headings: 1. Antitrust law. Conventional legal analysis will focus on new judicial decisions and enforcement initiatives. A special effort will be made to consider whether there are boundaries beyond which the law should not go in scrutinizing professional activities such as peer review, credentialling, and accreditation and whether the general procompetitive policy of the antitrust laws should be relaxed to accomodate collective efforts to contain costs. 2. Health planning, certification of need, and rate-setting regulation. Research will address developments in state regulation following impending changes in federal health planning legislation. The compatibility of entry controls and ratesetting regulation with federal procompetitive policies will be a particular concern. 3. Barriers to competitively induced change. Regulatory and private law (i.e., tort and contract law) constraints on privately initiated innovation will be studied. Collaboration with the Duke Center for Health Policy Research and Education will focus on legal problems in the implementation of responsible departures from professionally accepted standards of practice. 4. Competition studies. Developments in national policy will be monitored for consistency with and effectiveness in advancing the policy of fostering competition and decentralization of decision making. A major conference will be held to examine recent and proposed market-oriented reforms in the Medicare and Medicaid programs.
