HOW DOES APPLYING COMPETITION LAW IMPACT HEALTHCARE PROVISION IN - PowerPoint PPT Presentation

HOW DOES APPLYING COMPETITION LAW IMPACT HEALTHCARE PROVISION IN THE NETHERLANDS AND ENGLAND? Mary Guy UEA Law School / Centre for Competition Policy (CCP), University of East Anglia (UEA), Norwich. UK. European Health Law Conference PhD Satellite Event Riga, 30 April 2014 1/5

Competition (law) and healthcare… • The Netherlands: - Mandatory private health insurance since 2006; - “Healthcare triangle”: healthcare consumers, health insurers and healthcare providers; - Regulated by the ACM, NZa and IGZ – “general consumer interest”… • England: - Purchaser/Provider split since NHS Internal Market (1991); - 1990s - : Increased private sector involvement in the NHS; - Health and Social Care Act 2012: “competitive neutrality”…regulated by the CMA and Monitor… • Competition law now considered to apply to healthcare in both countries… 2/5

Undertakings and healthcare: Is there an “economic activity”? Competition concerns Level Does competition law apply? (subject to SGEI) • State aid • Macro Act of imperium: no; - Dutch RES; • State as “undertaking”: yes. (State intervention) Public hospital funding… - • Yes, unless : - System based on solidarity ( Poucet Meso • Abuse of dominance & Pistre ); (healthcare “managing Only “some room” for competition - - UK Pharma cases; bodies” – insurers and Problematic… ( AOK Bundesverband ); - commissioners) - Purchasing activity with an ultimately social aim ( FENIN ). • Anticompetitive • Yes. agreements Micro - Independent medical specialists - Continuity of care; (healthcare providers) ( Pavlov ); - Professional - Hospitals ( Commission ). associations… SGEIs: Risk Equalisation Schemes, Emergency Ambulance Services, and…? 3/5

Conclusion: How competition law impacts healthcare provision … • Affects the role of the Secretary of State/ Health minister… - “ juridification ” of matters previously deemed to be public policy (Davies) . • May not assist with dominance of key players (e.g. health insurers in the Netherlands); - Need to distinguish between different barriers to entry (Odudu) . • Effects at the level of the doctor-patient relationship are unknown… - Patients as final consumers of healthcare (Sauter) , but not the only consumers… 4/5

Any Questions? Thank you! 5/5