Balancing economic freedom against social policy principles: EC competition law and national health systems

Mossialos, Elías; Lear, J. M.

doi:10.1016/j.healthpol.2012.03.008

Cited by 10 publications

(10 citation statements)

References 16 publications

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“…European competition law prohibits public subsidization of an insurer in a competitive market [ 25 ]. The Irish government initially aspired to design a system exempt from European and national competition law [ 3 ], but recently reversed this stance and stated that competition law shall apply [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“Managed competition” for Ireland? The single versus multiple payer debate

Mikkers

Ryan

2014

BMC Health Serv Res

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BackgroundA persistent feature of international health policy debate is whether a single-payer or multiple-payer system can offer superior performance. In Ireland, a major reform proposal is the introduction of ‘managed competition’ based on the recent reforms in the Netherlands, which would replace many functions of Ireland’s public payer with a system of competing health insurers from 2016. This article debates whether Ireland meets the preconditions for effective managed competition, and whether the government should implement the reform according to its stated timeline. We support our arguments by discussing the functioning of the Dutch and Irish systems.DiscussionAlthough Ireland currently lacks key preconditions for effective implementation, the Dutch experience demonstrates that some of these can be implemented over time, such as a more rigorous risk equalization system. A fundamental problem may be Ireland’s sparse hospital distribution. This may increase the market power of hospitals and weaken insurers’ ability to exclude inefficient or poor quality hospitals from contracts, leading to unwarranted spending growth. To mitigate this, the government proposes to introduce a system of price caps for hospital services.The Dutch system of competition is still in transition and it is premature to judge its success. The new system may have catalyzed increased transparency regarding clinical performance, but outcome measurement remains crude. A multi-payer environment creates some disincentives for quality improvement, one of which is free-riding by insurers on their rivals’ quality investments. If a Dutch insurer invests in improving hospital quality, hospitals will probably offer equivalent quality to consumers enrolled with other insurance companies. This enhances equity, but may weaken incentives for improvement. Consequently the Irish government, rather than insurers, may need to assume responsibility for investing in clinical quality. Plans are in place to assure consumers of free choice of insurer, but a key concern is a potential shortfall of institutional capacity to regulate managed competition.SummaryManaged competition requires a long transition period and the requisite preconditions are not yet in place. The Irish government should refrain from introducing managed competition until sufficient preconditions are in place to allow effective performance.

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Section: Discussionmentioning

confidence: 99%

“Managed competition” for Ireland? The single versus multiple payer debate

Mikkers

Ryan

2014

BMC Health Serv Res

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“…31 I. Špokienė, "Solidarumo principo turinys ir vaidmuo sveikatos priežiūros teisinio reguliavimo srityje", Jurisprudencija, 3 (121), 2010, p. 328-348; I. Špokienė, "Lietuvos teisės aktuose asmeniui ir valstybei adresuotų pareigų "rūpintis sveikata" teisinis vertinimas", Sveikatos politika ir valdymas, 1 (4), 2012, p. 7-23; L. Murauskienė et al, "Lithuania: health system review", Health Systems in Transition, 15 (2), 2013, p. 1-150; J. Januševičienė, "Paciento pareiga rūpintis savo sveikata kaip teisės į sveikatos priežiūros paslaugas įgyvendinimo sąlyga", Teisė, 104, 2017, p. 184-197. 32 33 Šią sveikatos priežiūros paslaugų prieinamumo didinimo priemonę sveikatos priežiūros paslaugų teikėjai vertino labai nepalankiai. Jų manymu, tokių reikalavimų įgyvendinti praktiškai neįmanoma dėl per mažo specialistų skaičiaus ir jų netenkinančio darbo užmokesčio, todėl įstatymų leidėjas, prieš įsigaliojant minėtai nuostatai, metams atidėjo šios įstatymo nuostatos taikymą 34 , kol bus sprendžiami sveikatos priežiūros sektoriaus finansavimo didinimo ir kiti su įgyvendinimu susiję klausimai.…”

Section: Sveikatos Priežiūros Paslaugų Prieinamumo Reguliavimas Lietuunclassified

Asmens sveikatos priežiūros paslaugų prieinamumo reglamentavimo tendencijos Europos Sąjungoje ir Lietuvoje

Astromskė¹

2018

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“…that markets only maximize welfare as long as competition is secured, would not apply to healthcare [7][8][9]. Second, that the furtherance of the public healthcare interests would fall short if competition enforcement in healthcare is standard [7,17]. Third, that imperfect regulation of healthcare markets would call for healthcare-specific competition enforcement [9,18].…”

Section: Healthcare-specific Competition Enforcement Is Conceptually mentioning

confidence: 99%

“…Since the general legal framework for competition enforcement has developed in markets having less market failures than healthcare markets, this framework would not do for healthcare [7]. Consequently, health systems scrutinized under competition law would risk that noncompetition gains in consumer welfare are not adequately accounted for [17]. However, those arguments misunderstand the workings of the competition rules under the current economic approach.…”

Section: Healthcare Interests Do Not Suffer From Standard Competitionmentioning

confidence: 99%

Public healthcare interests require strict competition enforcement

Loozen¹

2015

Health Policy

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Balancing economic freedom against social policy principles: EC competition law and national health systems

Cited by 10 publications

References 16 publications

“Managed competition” for Ireland? The single versus multiple payer debate

“Managed competition” for Ireland? The single versus multiple payer debate

Asmens sveikatos priežiūros paslaugų prieinamumo reglamentavimo tendencijos Europos Sąjungoje ir Lietuvoje

Public healthcare interests require strict competition enforcement

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