NMa imposes strict conditions on hospital merger


Zeelandic hospitals approved to merge in the interest of hospital-care quality

After extensive investigation and under strict conditions, the Netherlands Competition Authority (NMa) has given its approval for the merger of Walcheren Hospital (located in the Dutch city of Flushing) and the Oosterschelde Hospitals (located in Goes and Zierikzee) in order to safeguard the quality of essential basic hospital care in the central region of the Dutch province of Zeeland. The NMa will closely monitor compliance with the conditions, and will work together with the Dutch Healthcare Authority (NZa) and the Netherlands Health Care Inspectorate (IGZ).

In its decision, the NMa comes to the conclusion that, after the merger, patients in central Zeeland will be left with very few options, and that the merger hospital will virtually have a monopoly position. Normally, this would be reason enough for the NMa to reject a merger. However, because a merger is necessary to guarantee the continuity of hospital care in this region, the NMa has nevertheless approved this merger.

Conditions to merger
The hospitals offered to comply with strict conditions. This would guarantee the continuity of basic hospital care, safeguard the claimed quality improvements, and take away the risk of the identified problems to competition. The conditions attached to the merger include a price cap for non-regulated medical services based on a national price average, and the creation of essential medical facilities for basic hospital care, such as an intensive-care unit and an emergency room. In addition, the hospital has to facilitate the possible entry of new providers of specialist medical care in the region by, for example, offering surgery-room facilities.

Opinions of IGZ and NZA
The opinions of IGZ and NZa weighed heavily with the NMa in its decision. The IGZ states in its advice that the central-Zeeland population size is too small to have basic hospital care be offered by two hospitals. In the eyes of IGZ, central Zeeland, basically a peninsula in the sparsely populated southwestern corner of the Netherlands, should be considered as a unique region in the Netherlands, due to its isolated geographical position. Other small Dutch hospitals have the option of turning to nearby, larger (academic or top clinical) hospitals to compensate for possible shortcomings – an option the hospitals in central Zeeland do not have. Based on IGZ's qualitative judgment, NZa gave a positive advice on the merger, provided that drawbacks will be dealt with appropriately. Other parties involved, such as health care insurers, clients' councils, patients' associations and general practitioners, have also indicated that basic hospital care would be at risk if the merger would not go through.

Monitoring hospital care in central Zeeland
The NMa will check whether conditions are met, in particular those related to affordability and quality offered by the new hospital, possibly calling in NZa and IGZ for their expertise. In addition, the NMa and NZa will continue to jointly monitor the developments regarding general hospital care in central Zeeland.