title: Policies towards hospital and GP competition in five European countries.
abstract: This study provides an overview of policies affecting competition amongst hospitals and GPs in five European countries: France, Germany, Netherlands, Norway and Portugal. Drawing on the policies and empirical evidence described in five case studies, we find both similarities and differences in the approaches adopted. Constraints on patients' choices of provider have been relaxed but countries differ in the amount and type of information that is provided in the public domain. Hospitals are increasingly paid via fixed prices per patient to encourage them to compete on quality but prices are set in different ways across countries. They can be collectively negotiated, determined by the political process, negotiated between insurers and providers or centrally determined by provider costs. Competition amongst GPs varies across countries and is limited in some cases by shortages of providers or restrictions on entry. There are varied and innovative examples of selective contracting for patients with chronic conditions aimed at reducing fragmentation of care. Competition authorities do generally have jurisdiction over mergers of private hospitals but assessing the potential impact of mergers on quality remains a key challenge. Overall, this study highlights a rich diversity of approaches towards competition policy in healthcare.
authors.affiliation: Department of Economics and Related Studies, University of York, YO10 5DD York, United Kingdom. Electronic address: luigi.siciliani@york.ac.uk.
authors.forename: Luigi
authors.initials: L
authors.lastname: Siciliani
authors.affiliation: Centre for Health Economics, University of York, YO10 5DD York, United Kingdom. Electronic address: martin.chalkley@york.ac.uk.
authors.forename: Martin
authors.initials: M
authors.lastname: Chalkley
authors.affiliation: Centre for Health Economics, University of York, YO10 5DD York, United Kingdom. Electronic address: hugh.gravelle@york.ac.uk.
authors.forename: Hugh
authors.initials: H
authors.lastname: Gravelle
mesh_terms: D002755:Choice Behavior; D004465:Economic Competition / Q000191:economics*; D005060:Europe; D058005:General Practitioners / Q000191:economics*; D033161:Government Regulation; D006273:Health Facility Merger; D006291:Health Policy; D006761:Hospitals / Q000639:trends*; D006801:Humans; D033181:Information Dissemination; D018854:Managed Competition / Q000191:economics*; D011787:Quality of Health Care
keywords: Competition; GPs; Hospitals; Patient choice; Quality