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Interactions in the healthcare system today involve an important new set of actors: evaluative health platforms (EHPs). These platforms are not neutral intermediaries, but active moderators of how patients express opinions, choose providers, and consume health-related information. This paper adds to our understanding of the varied and evolving commercial interests of EHPs and the implications these have for patient voice. We analyze 71 platforms in the USA, UK, and Germany and identify five ideal types: subscribers, analyzers, advertisers, regulators, and scammers. Each platform type enacts a unique competitive strategy through an evaluative infrastructure which constrains but also generates possibilities for patient voice. Based on our typology, we develop three contributions. First, we nuance universalizing claims about the consequences of platform capitalism by specifying the diverse strategies underpinning competition between EHPs in different countries, and showing how each strategy leads evaluative infrastructures to develop in ways that impact patient voice. Second, we show how patients can navigate the challenges of a complex EHP space by exercising their ability to choose between platforms. Finally, we outline the conditions platforms need to fulfil to become empowering. Overall, this study highlights the varied and complex relationship between platform business models and user voice, which exists not only in healthcare, but also in many other fields. • Typology of evaluative health platforms (EHPs) in the US, the UK, and Germany. • EHP business models and content moderation techniques vary considerably. • EHPs have a wide range of implications for patient voice. • More transparency and competition can help platforms increase patient empowerment. [ABSTRACT FROM AUTHOR]

France has a single-payer health insurance system that has the authority to impose pharmaceutical price reductions but relies on decentralized market negotiations between hospitals and manufacturers to establish prices for injected and infused biologies. Hospitals rely on biosimilars--less expensive but therapeutically equivalent variants of biologic medications--to stimulate competition. Price reductions negotiated by hospitals subsequently are adopted by the health insurance system, driving hospitals to negotiate a new round of discounts. This article measures 2004-20 trends in prices, price reductions, utilization, and market shares for three prominent biologies--Remicade, Enbrel, and Humira--and their eleven competing biosimilars. Biosimilar launches are associated with a sequence of price reductions for the reference biologic, for other biologies that treat similar conditions, and for all related biosimilars. The French experience provides lessons for the US in its efforts to use competition from biosimilars to drive price reductions and savings from biologies. [ABSTRACT FROM AUTHOR]

Background: It is uncertain whether consolidation in health care markets affects the quality of care provided and health outcomes.Objectives: To examine whether changes in market competition resulting from acquisitions by two large national for-profit dialysis chains were associated with patient mortality.Methods: We identified patients initiating in-center hemodialysis between 2001 and 2009 from a registry of patients with end-stage renal disease in the United States. We considered two scenarios when evaluating consolidation from dialysis facility acquisitions: one in which we considered only those patients receiving dialysis in markets that became substantially more concentrated to have been affected by consolidation, and the other in which all patients living in hospital service areas where a facility was acquired were potentially affected. We used a difference-in-differences study design to examine the associations between market consolidation and changes in mortality rates.Results: When we considered the 12,065 patients living in areas that became substantially more consolidated to have been affected by consolidation, we found a nominally significant (8%; 95% confidence interval 0%-17%) increase in likelihood of death after consolidation. Nevertheless, when we considered all 186,158 patients living in areas where an acquisition occurred to have been affected by consolidation, there was no observable effect of market consolidation on mortality.Conclusions: Decreased market competition may have led to increased mortality among a relatively small subset of patients initiating in-center hemodialysis in areas that became substantially more concentrated after two large dialysis acquisitions, but not for most of the patients living in affected areas. [ABSTRACT FROM AUTHOR]

Objective: To examine the effects of hospital and insurer markets concentration on transaction prices for inpatient hospital services.Data Sources: Measures of hospital and insurer markets concentration derived from American Hospital Association and HealthLeaders-InterStudy data are linked to 2005-2008 inpatient administrative data from Truven Health MarketScan Databases.Study Design: Uses a reduced-form price equation, controlling for cost and demand shifters and accounting for possible endogeneity of market concentration using instrumental variables (IV) technique.Principal Findings: The findings suggest that greater hospital concentration raises prices, whereas greater insurer concentration depresses prices. A hypothetical merger between two of five equally sized hospitals is estimated to increase hospital prices by about 9 percent (p < .001). A similar merger of insurers would depress prices by about 15.3 percent (p < .001). Over the 2003-2008 periods, the estimates imply that hospital consolidation likely raised prices by about 2.6 percent, while insurer consolidation depressed prices by about 10.8 percent. Additional analysis using longer panel data and applying hospital fixed effects confirms the impact of hospital concentration on prices.Conclusion: The findings provide support for strong antitrust enforcement to curb rising hospital service prices and health care costs. [ABSTRACT FROM AUTHOR]

Since the 1970s, market restructuring has shifted many workers into workplaces heavily reliant on sales to outside corporate buyers. These outside buyers wield substantial power over working conditions among their suppliers. During the same period, wage growth for middle-income workers stagnated. By extending organizational theories of wage-setting to incorporate interactions between organizations, I predict that wage stagnation resulted in part from production workers’ heightened exposure to buyer power. Panel data on publicly traded companies shows that dependence on large buyers lowers suppliers’ wages and accounts for 10 percent of wage stagnation in nonfinancial firms since the 1970s. These results are robust to a series of supplementary measures of buyer power; instrumental variable analysis using mergers between buyers; corrections for selection and missing data; and controls for individual worker characteristics like education and occupation. The results show how product market restructuring and new forms of economic segmentation affect workers’ wages. The spread of unequal bargaining relations between corporate buyers and their suppliers has slowed wage growth for workers. [ABSTRACT FROM AUTHOR]

The article discusses research regarding rural grocery storeowners' perceptions of their communities, their business practices, and factors that influence their sustainability and the ability to support healthy food choices in Nebraska as of 2016. According to the article, storeowners reported on strategies that they employ to remain competitive by focusing on customer service and product quality. The public health aspects of obesity in America are examined, along with small U.S. stores.

The opening of the Thai tobacco market, following action brought by the US Trade Representative under the General Agreement on Tariffs and Trade, is seen as a key case study of the tensions between trade and health policy. Interpretations of the dispute cast it, either as an example of how trade agreements undermine national policy-making, or how governments can adopt effective public health protections compliant with international trade rules. As a UK-based company, British American Tobacco has been regarded as peripheral to this dispute. This paper argues that its close monitoring of the illegal trade during this period, the role of smuggling in the company's global business strategy, and its management of the relative supply and pricing of legal and illegal products after market opening provide a fuller understanding of the interests and roles of transnational tobacco companies and the government in this dispute. The findings have important policy implications, notably the role of effective governance in countries facing pressure to open their tobacco sectors, need to better understand corporate-level activities within an increasingly globalised tobacco industry, and need to address the intertwined legal and illegal trade in implementing the WHO Framework Convention on Tobacco Control Protocol to Eliminate Illicit Trade in Tobacco Products. [ABSTRACT FROM PUBLISHER]

The 2010 Affordable Care Act (ACA) represents a milestone in U.S. health care policy. The ACA moves the American health care system away, in important respects, from market-driven health care, including imposing new regulations on health insurers. Yet the ACA also relies, in other respects, on market forces to achieve its aims, including its embrace of health plan competition and high-deductible insurance. This article explores how the ACA balances liberal aspirations and market principles, and the implications for health reform implementation and the future of U.S. health care. [ABSTRACT FROM AUTHOR]

To social workers, extreme economic inequality is primarily a violation of social justice, but this article shows how growing economic inequality since the mid-1970s was not only unjust, but also dysfunctional to the U.S. economy and linked to the recent economic crisis with its devastating effects, particularly on the social work clientele. The article identifies interrelated changes in ideology, the market economy, and government policies since the mid-1970s; contrasts the political economy of this period with the preceding post-World War II decades when the trend was toward a "shared prosperity"; and shows how increased economic inequality and political consequences that undermined democracy itself contributed to the economic meltdown. The analysis has implications for the direction of social reform and for broadening the constituency of social movements in pursuit of the social work mission of social justice. How social workers can contribute to such movements and to a reduction of economic and political inequality is explored. [ABSTRACT FROM AUTHOR]

The fifty states will play a critical role in implementing the Affordable Care Act, and California is one of the states at the forefront of reform. The act can provide coverage to millions of currently uninsured Californians and offers important benefits in terms of more-affordable coverage, improved access to services, and better health outcomes. As the paper by Peter Long and Jonathan Gruber in this issue of Health Affairs notes, the ultimate effects of health reform in California will be influenced by the policy and program decisions that state lawmakers and administrators make during the next three years. Key issues include revamping cumbersome eligibility determination and enrollment processes that could prevent rapid enrollment in expanded public health insurance-but also affording that expansion in the face of large state budget deficits. California policy makers need to move thoughtfully and strategically to ensure that the potential of federal health reform becomes a reality for state residents. [ABSTRACT FROM AUTHOR]

The article discusses the knowledge of the combination of complexity science and more basic teachings of economic thought in the understanding of issues concerning antitrust in the U.S. It is necessary to consider the direct and indirect effects of the interaction of the market power in the business systems. However, the danger lies in the analysis of antitrust in which the focus may be diverted to narrow issues and missing the complex development and evolution of business systems.

The article discusses ways on how complexity and diversity affects antitrust in the U.S. The different approaches must be sampled and evaluated in order for an evolutionary competition to work. Moreover, it is essential to distinguish selection through the product market because consumers flock to the best deal. On the other hand, diversity is very essential in competition because it is useful in complex markets since in simple markets everyone knows what to do.

The article discusses the future challenges biosimilars markets in the U.S. It mentions that according to the 2014 analysis performed by the American nonprofit global policy think tank Rand Corp. which reveals that biosimilars are expected in reduction in biologic spending between 2014 and 2024. It also mentions the challenges associated with the manufacturing process behind biologics such as BPCI Act.

The article discusses the trends in the U.S. influenza vaccine market. Maintaining the strong growth momentum of the sector will be a key challenge in the future owing to increasing competition and market commoditization. The market is considered as a challenging sector as it requires annual updates and the demand for seasonal influenza vaccines is variable. The growing commoditization of influenza vaccines was triggered by the failure of the demand for seasonal influenza vaccination.