Health care providers and health insurers have to collaborate, as part of the initiative called ‘the Right Care in the Right Place’ (in Dutch: De Juiste Zorg op de Juiste Plek). Many forms of collaborations are allowed. However, collaborations can also go too far, thereby leaving patients and insured unable to benefit from them, for example, if prices go up, as the result of a collaboration, or if the incentive to improve quality disappears. The Netherlands Authority for Consumers and Markets (ACM) has therefore drawn up the ‘Policy Rule on the Right Care in the Right Place’, to explain in what situations ACM will act against collaborations. In this policy rule, it is explained that it will not impose any fines if collaborations meet five criteria.
Martijn Snoep, Chairman of the Board of ACM, comments: ‘A lot is going on in health care at the moment. Collaborations are needed in order to offer people high-quality, accessible and affordable health care. Any uncertainty about ACM’s fines will prevent such collaborations from getting off the ground. Yet, with room for dialog, they will. With this policy rule, we provide room for collaborations to take place, even for far-reaching forms of collaborations. However, we do insist on something in return: such collaborations must be established carefully, and they must have verifiable objectives. And all stakeholders, including patient organizations, need to be involved.’
ACM’s policy with regard to collaborations as part of ‘the Right Care in the Right Place’
ACM will not impose any fines if the arrangements regarding collaborations as part of ‘the Right Care in the Right Place’ meet five criteria:
- The arrangements are based on a factual and public analysis of the health care needs in the region;
- Health care providers, health care buyers, and patients or their representatives are fully involved;
- The objectives are concrete, measurable and verifiable, and they are phrased in terms of quality, accessibility, and affordability of health care;
- Market participants substantiate why the arrangements, if they restrict competition, are necessary for achieving the stated objectives;
- The objectives, the arrangements, and the substantiation of the necessity are made public.
If the arrangements violate the Dutch Competition Act, they will have to be adjusted, but ACM will not impose any fines.
Responses to the draft policy rule
During the summer, the draft policy rule was open for public consultation. ACM received 28 responses, which together represent the broader health care sector. These responses have led to a number of clarifications and changes. For example, the final version of the policy rule does not only apply to the relocation of health care, but also to the prevention of more expensive health care, and the replacement of health care by, for example, e-Health. In addition, ACM has clarified what it understands by fully involving patients or their representatives. This underlines the importance of the basic principle of ‘the Right Care in the Right Place’: the patient is central. In addition, the importance of a substantiation of the necessity of anticompetitive arrangements has been clarified further.
What is ‘the Right Care in the Right Place’?
‘The Right Care in the Right Place’ is an initiative of health-care market participants. They wish to prevent the need for receiving a more expensive form of health care, to provide health care closer to people’s homes, and to replace some forms of health care provision with other forms such as e-Health. All of this will help people with illnesses or disabilities live and function better. The Dutch Ministry of Health, Welfare and Sport (VWS) supports this initiative. With its policy rule, ACM contributes towards realizing high-quality, accessible, and affordable health care.
Collaborations in health care
Many forms of collaborations are allowed. But the competition rules do set boundaries, for example, boundaries to arrangements about who will offer what kind of health care and where. It is not self-evident that these kinds of arrangements, by definition, always lead to better or more affordable health care. These arrangements can also lead to higher prices, lower quality, and less innovation. Patients, insured, professionals, and market participants must be able to have confidence that health care markets, too, continue to function well. With this policy rule, ACM provides room for collaborations in the interest of patients and insured. ACM will act against arrangements that restrict competition, and harm patients and insured.