After an extensive investigation in the licensing phase, the Netherlands Competition Authority (NMa) has given its approval to the merger between the AMC de Meren and JellinekMentrum Foundations. These are care institutions that provide mental health care (Dutch abbreviation: GGZ) in Amsterdam and Diemen. Sufficient competition will remain even after the merger, and patients as well as care purchasers will retain the possibility of selecting other GGZ providers.
Both AMC de Meren and JellinekMentrum are active in the area of non-clinical GGZ (health care without admission into hospital, provided in the institution or at the patients' home). The geographical market comprises Amsterdam and Diemen, as shown by the current referral behaviour, current travel behaviour of patients and a travel time analysis made by the NMa. The supervisory body's investigation included whether the organisations will still experience sufficient pressure after the merger from competitors, so that care purchasers (Amsterdam care administration and health care insurers) and patients will retain their freedom of choice.
Non-clinical GGZ: no hindrance to patients
The market for non-clinical GGZ for adults and the elderly is heterogeneous: not only do integrated GGZ institutions (institutions that provide non-clinical as well as clinical GGZ) compete among each other, but also with independent psychiatrists and psychotherapists, as well as with non-integrated GGZ providers. The NMa concludes that there will still be enough competitors in Amsterdam and Diemen after the merger, such as the Buitenamstel de Geestgronden Foundation (SBG), non-integrated providers and independent psychiatrists and psychotherapists. This means that health insurers can also purchase mental health care from competitors in the event of possible price increase or quality reduction of the merging organisations. Moreover, there is nothing to hinder patients from choosing a (different) provider of non-clinical GGZ. Furthermore, it is relatively easy for new providers to enter parts of this market: various, mostly nationally operating care providers such as PsyQ/Parnassia, 1nP and Mentaal Beter also entered the Amsterdam and Diemen region last year.
Clinical GGZ: freedom of choice guaranteed
SBG appears to be a strong competitor in the clinical GGZ field. This institution can refer its patients internally and admit them to facilities in the vicinity outside Amsterdam (such as Amstelveen, Bennebroek and Haarlem). This is already being done in practice at this time. In addition to this there is another provider active in Amsterdam and Diemen with the presence of the Sint Lucas Andreas Hospital, which has a psychiatric department (PAAZ). The market study did not provide any concrete evidence that the merger will have negative consequences on prices and/or quality. Changes in regulations might also have an effect on the travel behaviour of patients in the future, so that non-Amsterdam GGZ institutions in the vicinity will also be able to form an alternative for Amsterdam residents.
Considering the fact that another provider with a comparable capacity will remain in Amsterdam, that there is PAAZ, and that a number of integrated institutions are active in the near vicinity of Amsterdam, sufficient alternatives remain available. This means that patients and care purchasers can opt for a different care provider if they consider this desirable.
In case of mergers and takeovers, the NMa evaluates whether the actual competition will be significantly hampered, particularly due to the creation or reinforcement of an economical power position. Such a power position may have negative consequences on price, quality and diversity of the supply. Competition is important because it stimulates organisations to make an effort to provide more and better products and services. For consumers, competition provides the necessary advantages: it generally results in more (freedom of) choice, higher quality and lower prices.
In the first-phase investigation (dated 3 August 2007) the NMa concluded that further investigation was required for this merger. The Competition Authority therefore carried out an extensive investigation in the subsequent licensing phase. The outlook of various interested parties in the health care sector are also involved in this investigation, such as other GGZ institutions, health care administration offices, health insurers and special interest associations. The Dutch Healthcare Authority (NZa) endorses the conclusions of the NMa in its point of view, and concludes that the merger will not have any negative consequences for accessibility, affordability and quality of mental health care in Amsterdam and Diemen.
The merger decision will be published as soon as possible on the NMa website (www.acm.nl).