The phrase “hospital desert” sanitizes a brutal reality for millions of rural Americans: the closure of a local hospital means longer journeys for life-saving care, worse health outcomes, and the hollowing out of fragile local economies. While many commentators point to demographic changes and strained budgets as primary causes of this growing crisis, in her compelling new article, The Healing Power of Antitrust, Theodosia Stavroulaki argues that we have been misdiagnosing the problem. She shows that hospital deserts are also the product of anticompetitive practices and enforcement failures—noncompete clauses that drive clinicians away, hospital mergers that strip rural communities of services, and regulatory blind spots that treat closures as unavoidable. Stavroulaki calls for antitrust enforcers to embrace their “healing power” by addressing these practices head-on, proposing reforms that expand merger analysis to labor markets, ban healthcare noncompete agreements, and condition rural hospital mergers on commitments to preserve services. Stavroulaki thus shows that antitrust is not simply a tool for protecting consumer welfare, but can also advance health equity by addressing the geographic disparities that leave rural patients behind.
Stavroulaki begins by powerfully situating what is at stake with the rural hospital closure crisis. Rural hospitals serve communities that are poorer, older, sicker, and more likely to be uninsured. These communities also experience higher rates of chronic conditions, disability, and substance use. Unsurprisingly, rural communities rely heavily on their hospitals to meet their healthcare needs. Moreover, because hospitals are often the largest local employer—generating jobs, purchasing goods and services, and sustaining community life—many rural hospitals serve as their community’s economic anchor. When a rural hospital closes, the resulting hospital desert can devastate the community, endangering lives and destabilizing the local economy.
Part II of the article then reviews various policy interventions designed to ameliorate the hospital-closure epidemic, namely telemedicine, Medicaid expansion, and health-promotion programs. While acknowledging their importance, Stavroulaki concludes that these measures are ultimately insufficient because they fail to address the deeper, structural causes of these closures —hospitals’ anticompetitive business practices.
Part III turns to the article’s distinctive contribution: reframing the rural health crisis as an antitrust problem. Stavroulaki traces hospital deserts to both the output and input markets. On the output side, she explains that while hospital systems may justify their acquisition of smaller rural competitors on efficiency grounds, in reality, many wish to eliminate their rural competitors and consolidate market power. Post-merger, acquiring facilities are often closed or stripped of essential services like obstetric, psychiatric, or emergency care.
On the input side, Stavroulaki delivers an astute analysis of labor market monopsony, showing how consolidation gives hospital systems immense leverage as the primary employer of clinicians in a region. That power is used to suppress wages and impose burdensome working conditions, fueling physician burnout. It also enables the widespread use of noncompete agreements that trap doctors and nurses. By preventing clinicians from simply moving to nearby healthcare facilities, noncompetes exacerbate the very staffing shortages that make rural hospitals so vulnerable, often forcing unhappy professionals to either leave the region or the healthcare workforce altogether.
By weaving together these output and input effects, Stavroulaki underscores how consolidation and anticompetitive practices contribute to the hospital desert crisis, setting the stage for the antitrust remedies she develops in Part IV.
Part IV turns from diagnosis to prescription, showing how antitrust enforcers can use existing law to stem the rise of hospital deserts. Stavroulaki begins with noncompete clauses, offering a nuanced analysis as to why restraints that prevent clinicians from practicing in nearby communities should be treated as per se violations of Section 1 of the Sherman Act. Importantly, her arguments enrich the ongoing debate over noncompete agreements sparked by the Federal Trade Commission’s 2024 proposal to prohibit such agreements and a federal district court decision striking down the FTC’s rule.1
Turning to hospital mergers, Stavroulaki argues that Section 7 of the Clayton Act should be interpreted to capture monopsony power in healthcare labor markets, and not simply monopoly power in output markets like the price and quality of hospital services. She therefore calls for hospital merger reviews to assess the merger’s impact on clinicians’ wages, working conditions, and flight from rural communities. Stavroulaki further urges antitrust regulators to broaden their focus beyond price effects alone and condition approval of rural mergers on commitments to keep acquired facilities open and preserve essential services. These proposals are especially timely as the Department of Justice and the Federal Trade Commission reconsider their hospital merger framework following the withdrawal of their long-standing healthcare merger guidelines.
Over 130 rural hospitals have closed since 2010, with experts warning that more than 600 others are at risk of closure. In this moment of profound crisis for rural health, The Healing Power of Antitrust shows how antitrust law can be more than a safeguard for excessive prices—it can be a tool for preserving the hospital institutions that are the lifeblood of rural communities. By both showing how anticompetitive practices can lead to hospital deserts and offering a concrete agenda for enforcement, Stavroulaki shifts the conversation around rural healthcare beyond demographic changes and reimbursement to the hidden role of market power. Doctrinally innovative and profoundly timely, her article offers a compelling vision of how antitrust law can help close the geographic gaps that perpetuate inequities in health access and outcomes.
- Ryan LLC v. Fed. Trade Comm’n, No. 3:24-cv-00986-E, 2024 WL 3879954 (N.D. Tex. Aug. 20, 2024) (holding that the FTC exceeded its statutory authority in issuing its rule banning most noncompete agreements, and that the rule was arbitrary and capricious). Although the FTC initially appealed the district court decision, on September 5, 2025, the agency dismissed its appeal and acceded to the vacatur.
