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Policies towards hospital and GP competition in five European countries

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  • Siciliani, Luigi
  • Chalkley, Martin
  • Gravelle, Hugh

Abstract

This study provides an overview of policies affecting competition amongst hospitals and GPs in five European countries: France, Germany, Netherlands, Norway and Portugal. Drawing on the policies and empirical evidence described in five case studies, we find both similarities and differences in the approaches adopted. Constraints on patients’ choices of provider have been relaxed but countries differ in the amount and type of information that is provided in the public domain. Hospitals are increasingly paid via fixed prices per patient to encourage them to compete on quality but prices are set in different ways across countries. They can be collectively negotiated, determined by the political process, negotiated between insurers and providers or centrally determined by provider costs. Competition amongst GPs varies across countries and is limited in some cases by shortages of providers or restrictions on entry. There are varied and innovative examples of selective contracting for patients with chronic conditions aimed at reducing fragmentation of care. Competition authorities do generally have jurisdiction over mergers of private hospitals but assessing the potential impact of mergers on quality remains a key challenge. Overall, this study highlights a rich diversity of approaches towards competition policy in healthcare.

Suggested Citation

  • Siciliani, Luigi & Chalkley, Martin & Gravelle, Hugh, 2017. "Policies towards hospital and GP competition in five European countries," Health Policy, Elsevier, vol. 121(2), pages 103-110.
  • Handle: RePEc:eee:hepoli:v:121:y:2017:i:2:p:103-110
    DOI: 10.1016/j.healthpol.2016.11.011
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    References listed on IDEAS

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    1. R. Halbersma & M. Mikkers & E. Motchenkova & I. Seinen, 2011. "Market structure and hospital–insurer bargaining in the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(6), pages 589-603, December.
    2. Choné, Philippe, 2017. "Competition policy for health care provision in France," Health Policy, Elsevier, vol. 121(2), pages 111-118.
    3. Puck Beukers & Ron Kemp & Marco Varkevisser, 2014. "Patient hospital choice for hip replacement: empirical evidence from the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(9), pages 927-936, December.
    4. Gaynor, Martin & Town, Robert J., 2011. "Competition in Health Care Markets," Handbook of Health Economics, Elsevier.
    5. Kifmann, Mathias, 2017. "Competition policy for health care provision in Germany," Health Policy, Elsevier, vol. 121(2), pages 119-125.
    6. Martin Gaynor, "undated". "What Do We Know About Competition and Quality in Health Care Markets?," GSIA Working Papers 2006-E62, Carnegie Mellon University, Tepper School of Business.
    7. Brekke, Kurt R. & Straume, Odd Rune, 2017. "Competition policy for health care provision in Norway," Health Policy, Elsevier, vol. 121(2), pages 134-140.
    8. Varkevisser, Marco & van der Geest, Stéphanie A. & Schut, Frederik T., 2012. "Do patients choose hospitals with high quality ratings? Empirical evidence from the market for angioplasty in the Netherlands," Journal of Health Economics, Elsevier, vol. 31(2), pages 371-378.
    9. Pilny, Adam & Mennicken, Roman, 2014. "Does Hospital Reputation Influence the Choice of Hospital?," Ruhr Economic Papers 516, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    10. Tor Iversen & Ching-to Ma, 2011. "Market conditions and general practitioners’ referrals," International Journal of Health Economics and Management, Springer, vol. 11(4), pages 245-265, December.
    11. Schut, Frederik T. & Varkevisser, Marco, 2017. "Competition policy for health care provision in the Netherlands," Health Policy, Elsevier, vol. 121(2), pages 126-133.
    12. repec:zbw:rwirep:0516 is not listed on IDEAS
    13. Barros, Pedro Pita, 2017. "Competition policy for health care provision in Portugal," Health Policy, Elsevier, vol. 121(2), pages 141-148.
    14. Heijink, Richard & Mosca, Ilaria & Westert, Gert, 2013. "Effects of regulated competition on key outcomes of care: Cataract surgeries in the Netherlands," Health Policy, Elsevier, vol. 113(1), pages 142-150.
    15. Schmid, Andreas & Varkevisser, Marco, 2016. "Hospital merger control in Germany, the Netherlands and England: Experiences and challenges," Health Policy, Elsevier, vol. 120(1), pages 16-25.
    16. Varkevisser, Marco & Schut, Frederik T., 2012. "The impact of geographic market definition on the stringency of hospital merger control in Germany and the Netherlands," Health Economics, Policy and Law, Cambridge University Press, vol. 7(03), pages 363-381, July.
    17. Choné, P. & Coudin, É. & Pla, A., 2014. "Are physician fees responsive to competition?," Health, Econometrics and Data Group (HEDG) Working Papers 14/20, HEDG, c/o Department of Economics, University of York.
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    Cited by:

    1. Rudy Douven & Monique Burger & Erik Schut, 2018. "Does managed competition constrain hospitals’ contract prices? Evidence from the Netherlands," CPB Discussion Paper 378, CPB Netherlands Bureau for Economic Policy Analysis.
    2. repec:eee:jhecon:v:57:y:2018:i:c:p:290-314 is not listed on IDEAS
    3. repec:eee:hepoli:v:121:y:2017:i:12:p:1203-1207 is not listed on IDEAS
    4. Giuseppe Moscelli & Hugh Gravelle & Luigi Siciliani & Nils Gutacker, 2017. "The effect of hospital ownership on quality of care: evidence from England," Working Papers 145cherp, Centre for Health Economics, University of York.

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    Keywords

    Competition; Patient choice; Hospitals; GPs; Quality;

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