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

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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…

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Undertakings and healthcare: Is there an “economic activity”?

Level Does competition law apply?

Competition concerns (subject to SGEI)

Macro

(State intervention)

Meso

(healthcare “managing bodies” – insurers and commissioners)

Micro

(healthcare providers)

• Act of imperium: no;
• State as “undertaking”: yes.
• Yes, unless:
• System based on solidarity (Poucet

& Pistre);

• Only “some room” for competition

(AOK Bundesverband);

• Purchasing activity with an

ultimately social aim (FENIN).

• Yes.
• Independent medical specialists

(Pavlov);

• Hospitals (Commission).
• State aid
• Dutch RES;
• Public hospital funding…
• Abuse of dominance
• UK Pharma cases;
• Problematic…
• Anticompetitive

agreements

• Continuity of care;
• Professional

associations…

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SGEIs: Risk Equalisation Schemes, Emergency Ambulance Services, and…?

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
• nly consumers…

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Any Questions? Thank you!

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