NMa and NZa: as long as patients benefit from cooperation, it is allowed
Hospitals are allowed to cooperate and make medical-specialty arrangements as long as patients demonstrably benefit from such arrangements. This was the message that 150 hospital and insurance executives heard at a recent conference, which was jointly organized by the Netherlands Competition Authority (NMa), the Dutch Healthcare Authority (NZa), and the Dutch Association of Hospitals (NVZ).
The goal of the conference, called Hospital Care and Market Oversight, was to explain to hospital executives the rules on cooperation, mergers, concentrations, dominant positions, and specialization in hospital care. Both the NMa and the NZa enforce oversight thereon. Theo Langejan, chairman of the Board of the NZa, said: ‘With the introduction of competition in the health care industry, hospitals have been given a lot of freedom, but, at the same time, it means that they need to comply with antitrust regulations. Within those boundaries, there is plenty of freedom to cooperate. Running a business means making choices and taking responsibility.’
Pieter Kalbfleisch, chairman of the Board of the NMa, said: ‘Hospitals are allowed to make medical-specialty arrangements. However, if they do, they will have to demonstrate that the quality benefits of their cooperation outweigh the disadvantages of, for example, reduced freedom of choice for patients and insurers. Mutual agreements cannot result in little or no competition.’ If hospitals needed to specialize in order to meet quality standards, insurers could play a role in determining what hospital will offer what care in the future, the NMa believes. After all, the Dutch health insurance system does offer insurers an influential role in that area, but it also mandates them to buy enough high-quality care.
Another important topic was how hospitals should behave if they enjoyed significant market power (SMP). Health care providers with SMP have such a strong position on the market that they are able to act independently of their competitors. If such a position of SMP negatively affects prices and quality of health care, and consumer choice, the NZa can take measures to prevent this.
Roelf de Boer, chairman of NVZ, said: ‘The bottom line is, we need to get to work. That has been today’s message. Hospitals are more of a doer. We should not be afraid of what is allowed, but we should know what is allowed.’ At the conference, hospital executives took the opportunity to ask the NMa and the NZa questions about obstacles they encounter with regard to cooperation and SMP.
The joint regulators will soon release a brochure aimed at hospitals, which can be used to assess whether or not certain forms of collaboration and specialization are allowed.
Revised protocol of cooperation
The NMa and the NZa have updated their protocol of cooperation. This protocol contains working arrangements, and offers a clear basis in order to execute their regulatory duties more effectively, and to prevent their activities from overlapping. It has been laid down, for example, that the NMa and the NZa consult with each other in cases involving mergers, acquisitions and market definition problems.