Utahns should understand some of the implications of the recent Federal Trade Commission decision requiring Columbia and HealthTrust to sell Jordan Valley Hospital, Pioneer Valley Hospital and Davis North Medical Center.

In spite of the good intentions of the FTC, the decision appears to:- Hurt Utah health-care consumers in terms of choice, access, continuity of care and cost.

- Backfire in preserving health-care market competition by hindering the development of a fully integrated delivery system as an alternative to Intermountain Health Care.

- Hamper the goals, philosophy and momentum of Gov. Mike Leavitt's "Utah Health Print" in terms of "market-oriented care," "bottom up and not from a government-mandated top down approach," and "fix(ing) the problems in the current market by enhancing competition rather than setting up a government-run system."

Market forces are beginning to check health-care costs. National 1995 HMO premiums have actually decreased from the previous year. This merger and what it does to the Utah health-care market are natural and timely results of market opportunities and exactly what should be allowed to happen. It is no coincidence that there have been two aggressive merger attempts in Utah in the past 18 months. The FTC's decision violates natural market forces.

Integrated delivery systems require a critical mass of resources and geographic coverage. Successful and efficient IDS must provide all services within the full continuum of care (from birth to death) by having geographically thorough resources i.e. 1) facilities (patient access and care delivery sites), 2) health-care providers at these locations, and 3) insurance products or health-care plans.

Because any IDS desiring to compete with another must necessarily overlap geographically with its competition, the FTC ruling to sell the three hospitals ruins the geographic integrity essential for any alternative IDS to successfully compete with IHC.

The FTC claims that its decision encourages the growth of a third or even fourth health-care system in Utah. However, it is doubtful that Utah could support the critical mass of resources necessary for more than two or questionably three fully developed IDS. There would be a high social cost for overcapacity and wasteful duplication for more than two or three full-scale burn centers, trauma centers or position emission tomography scanners.

The FTC decision's methodology is flawed. It is based on market share of licensed beds. This is an increasingly poor measure of activity because of the shift to outpatient care, and occupancy ranging from 20 percent to 80 percent of total beds in any given hospital.

The FTC would be more effective in facilitating competition by allowing an alternative IDS unrestricted until it matched IHC's market share. Or, if the FTC is committed to having players in Utah, it would do well to coordinate with the Federal Justice Department to reduce IHC's market share to 33 percent and allow two other systems to achieve 33 percent market share each.

Josh Nelson

Salt Lake City