NMa welcomes collective consultations to make health care quality more visible

The Netherlands Competition Authority (NMa) is favorable to individual health-care providers, such as general practitioners and physiotherapists, sitting down with each other and with health insurers on a national level making health care quality more visible. At the same time, however, the NMa is warning them that collective negotiations, for example on prices, volumes and market sharing, in order to form a counterweight vis-à-vis health insurers is still strictly prohibited. The NMa expressed its position during today's release of a vision document on individual and collective negotiations between health insurers and independent extramural health-care providers.

'If health-care providers conclude agreements on, for example, prices, it technically constitutes a cartel. And under the Dutch Competition Act, cartels are prohibited because they restrict options that patients and insured individuals can choose from. If consumers have too little to choose from, health care providers are no longer stimulated to work more efficiently nor to improve the quality of their care. This will ultimately lead to a deterioration of health care,' says Pieter Kalbfleisch, chairman of the Board of the NMa.

However, the NMa draws a different conclusion with regard to joint consultations on quality standards and indicators. Mr. Kalbfleisch explains: 'One of the greatest obstacles at the moment to competition in the health care industry is the lack of clarity concerning the quality that is delivered by health care providers. If joint consultations among health care providers on a national level lead to an improvement of the measurability of health care quality, I wholeheartedly welcome such collaborative efforts.' Improving the measurability of health care quality would better enable patients to choose the right health care provider. In addition, health insurers would make better choices when buying health care for their clients. The NMa is drawing a similar conclusion with regard to the development of a system in which health insurers pay part, or all of the costs that health care providers incur when innovating. After all, the NMa argues, innovation will benefit the health care providers, the health insurers, and ultimately the patients through improved service (now or in the future) or lower premiums.

The NMa launched the investigation because, in recent years, both the NMa and the Dutch Healthcare Authority (NZa) have received a series of complaints from various health care providers regarding health insurers allegedly having buyer power. In reaction to these complaints, both regulators set up round-table meetings between health care providers and health insurers. It turned out that health care providers are eager to form collectives vis-à-vis the health insurers, thereby creating a more balanced negotiating relationship. Drawing on their own expertise, the NZa and the NMa have both carried out additional and complementary studies into the negotiating relationship between health care providers and health insurers. Given its role and its duties, the NZa looked into the question of what the effects of buyer power and collective negotiations would be, in particular between health insurers and hospitals, and the curative mental health care industry (representation model), on the quality, accessibility, and affordability of health care. And in its research, the NMa analyzed whether, and in what situations, collective negotiations could be desirable (benefiting patients and/or insured), what risks would be involved, and how much leeway the Competition Act offers. Attention is also given to possible consequences and risks of health insurers' buyer power.

From their own perspectives, both regulators come to similar conclusions: collective consultations in order to make quality visible can stimulate competition. Collective negotiations on, for example, prices and local quality standards between health care providers and health insurers restrict competition. Both studies are published today.

The NMa's vision document (in Dutch) can be downloaded here. For the NZa's vision document (in Dutch), please visit www.NZa.nl (external website) .