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NMa Prohibits Agreements on Tariffs and on the Setting up of Practices by General Practitioners

In its decision on the policy with regard to setting up practices of Landelijke Huisartsenvereniging (LHV) [National Association of General Practitioners] and the collective negotiations conducted by bodies within this organisation, the Dutch Competition Authority (NMa) has determined that the agreements with regard to prices and the division of the market amongst its members is in conflict with the Competition Act. This decision is based on the fact that the legislature has introduced market forces into this part of the healthcare sector. Agreements with regard to the quality of care provided are not in conflict with the Competition Act.

LHV has indicated that it has already withdrawn its policy with regard to the setting up of practices. LHV has also expressed its willingness to make changes to the present system of collective negotiations. In order to allow general practitioners affiliated to the organisation to prepare for the new negotiating model, NMa has granted LHV a transitional period until 1 January 2002 to put these changes into effect.

In taking this decision NMa hopes to create greater clarity and to issue guidelines for all parties in drawing up a new policy with regard to contracts. In the period since NMa expressed its provisional objections to the former agreements last year, most healthcare insurers have developed new agreements and schemes that comply with the Competition Act.

In the first few months of is existence, NMa received more than 300 applications for exemption from the healthcare sector. Many of these applications related to the procurement of care by hospitals. Hospitals are legally obliged to procure sufficient care from healthcare providers for patients insured by health insurance funds. In 1992 an important amendment was made to the Health Insurance Act [Ziekenfondswet]. Since 1992 health insurance funds have not been obliged to enter into contracts with every healthcare provider. In 1992 the tariffs determined by the government for the services of certain healthcare providers were abolished. This means that healthcare providers have to compete with each other for contracts with health insurance funds. As a result, health insurance funds can procure care at more competitive rates, which, in turn, are translated into lower premiums.

Despite these amendments to the Act, numerous market players continued to negotiate both at the national and regional levels. LHV, for instance, entered into agreements at the national level on the tariffs that would apply to all general practitioners. In practice, this was always the maximum tariff. In addition, at the regional level, general practitioners jointly decided which general practitioner could set up a practice in any particular location and the maximum number of patients he could treat. The general practitioners with established practices could therefore exclude newcomers, even those offering better and more innovative forms of care.

NMa has now dealt with most of the applications for exemption from the healthcare sector. In many cases the parties amended their schemes after discussions with NMa, following which the application for exemption was withdrawn. In other cases NMa took a decision or is preparing a decision.