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Healthy collaborations in health care

The health care industry is changing. Health insurers, municipalities, and health care providers collectively bear responsibility for making sure that health care is accessible, affordable, and of high quality. Health care providers and health insurers often enter into collaborations. Collaborations can sometimes benefit consumers, but sometimes they do not.

The role of ACM

The Netherlands Authority for Consumers and Markets (ACM) wishes to offer room for collaborations in the health care market that offer benefits to consumers (both as patients and insured), for example, if they improve health care affordability or the quality of treatments. However, some forms of cooperation lead to market behaviour that does not benefit consumers such as price-fixing agreements or unnecessarily restricting the options of consumers when selecting a health care provider.

Responses to this theme

In a roundtable meeting, ACM sat down with representatives of health care providers to discuss collaborations in health care, and the associated practical problems that occur. According to several participants, the relationship between health insurers and providers is a cause for concern. Health insurers wish to keep prices low. That puts pressure on the quality of health care. Furthermore, several participants observe huge differences between municipalities when it comes to health care procurement. As a result of the occasionally low prices, some health care providers run into problems.


On the dedicated website for the online discussion (, three provocative statements were published about this theme: about cooperation between hospitals and health insurers, about ACM’s oversight of the primary care market, and finally, about procurement of long-term health care by municipalities. The first statement generated five responses. The main point of these responses is that health insurers still have a dominant (too dominant?) position in the negotiations.

Follow-up actions

By publishing market studies, best practices, and frameworks over the next two years, ACM will make clear what healthy cooperation entails. For example, we are conducting a market study into competition between health insurers, and we are carrying out a study into the negotiation process between health insurers and health care providers. We are also working on a vision document about collective procurement of expensive drugs by hospitals. We will continue to engage with the health care industry in order to promote collaborations in the interests of consumers.