Antitrust law may be a barrier to collaboration.

Other countries favor more regulatory strategies, such as all-payer rate setting for hospitals and physicians in Germany, and single-payer systems in France and Canada. New data show that the United States continues to spend far more than its Western allies on healthcare—and with lcss-than-universal coverage (George J. Schicber, Jean-Pierre Poullier, and Leslie M. Grccnwald, "Health Spending, Delivery, and Outcomes in OECD Countries," Health Affairs, Summer 1993). U.S . per capita spending on healthcare in 1991 exceeded spending in Canada by 50 percent, in Germany by 73 percent, and in France by 74 percent. The question now before American policymakers is this: Can the United States correct its failed healthcare markets via "managed competition," keep its healthcare costs in line with those around the world, and still ensure every American timely access to high-quality healthcare? This new "managed competition" preferred by President Bill Clinton incorporates two seemingly paradoxical philosophies. First is the notion that increased compe t i t i on a m o n g heal thcare providers and plans will lower the cost of healthcare and provide more consumer choice. The second idea follows the more collaborative lines of other nations' healthcare systems. Here the goal is to form purchasing cooperatives, alliances, or networks (depending on the terminology at the moment), to improve efficiency in the healthcare system, and to eliminate costly duplication of services and excess capacity.