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Utahns should prepare to have their health-care choices drastically limited. Soon most employers will have very few options but to enroll their employees in a system known as a classic health maintenance organization.

In Utah, the most notable HMO before now has been FHP. In this type of a system, an individual's choice as to which hospital and physician to use is intentionally limited and is based on cost savings to the system rather than preference or convenience for the consumer. Intermountain Health Care is rapidly implementing its own HMO as it buys large clinics, recruits new providers and forces existing physician practices into employment.IHC's present 55 percent share of the Utah health market is increasing at the rate of 24 percent per year and overshadows all competitors.

Unfortunately, the health-care market in Utah is not freely competitive. The IHC system has been given a multitude of advantages over its competitors. Twice during the past year the federal government has stopped IHC's weak and fragmented competitors from gaining any meaningful foothold in their uphill battle against the monopolistic giant.

The Federal Trade Commission claims that two strong health-care systems competing against one another in Utah would be undesirable when compared to having only one strong system with limited competition. The logic behind these rulings escapes understanding.

Last year the Holy Cross Health Care System (a devoted and historic Utah health-care provider) was forced out of the market due to increasing losses to IHC. HealthTrust of Utah likewise suffered losses to IHC. In a survival effort, HealthTrust attempted to grow to one half of the size of IHC, only for the FTC to block them from purchasing all of the three Holy Cross hospitals (leaving them with only 17 percent of the Utah hospital beds).

This year, as a result of a nationwide merger between HealthTrust Inc. (HTI) and Columbia/HCA, the newly created Columbia Utah system, with just 26 percent of hospital beds, would have barely reached the size that experts feel is necessary for stability in the Utah market.

In comparison, 18 hospitals are owned by IHC statewide (with four in Salt Lake County), while Columbia will own seven hospitals (with only one in Salt Lake county). In the meantime, IHC is buying clinics and physicians' practices and building new facilities in close proximity to its competitors, all without scrutiny from the FTC.

The result of this forced divestiture will be enhancement of the IHC monopoly and will have a seriously negative impact upon the residents of Utah. IHC will have free rein to push its HMO onto consumers. The "managed competition" spirit of health-care reform, which has been encouraged by Congress and espoused by Columbia, will not be given a chance to succeed in Utah.

How unfortunate that the FTC has apparently been influenced by the special interests of a few.

Arlen K. Jarrett, M.D.

Past member, Board of Directors

Holy Cross Health System of Utah