ACM has launched investigations into attempts by trade associations to influence individual health-care contracts

The Netherlands Authority for Consumers and Markets (ACM) has launched investigations into attempts by trade associations to influence the individual negotiations between health care providers and health insurers regarding the 2023 contracts.

ACM has picked up various signals indicating that trade associations of different health care providers send their members guiding information. According to these reports, trade associations of health-care providers, for example, ‘recommend’ using a certain percentage for price increases in their negotiations with health insurers. Such attempts by trade associations may lead to higher health-care costs and higher premiums for health insurances.

What is this case about?

Each fall, health insurers must reach an agreement with health-care providers about the care that they purchase for their clients, the insured. To that end, health-care providers negotiate individually with health insurers. In that way, health insurers are able to purchase the care that meets the needs of their clients. And those clients, in turn, are able to choose the policy that best meets their needs on the basis of clarity over which health-care providers have been contracted. In that context, health insurers have a duty to buy sufficient health-care services of good quality. The negotiations for the 2023 contracts have been going on for a while now. ACM has picked up various signals indicating possible violations of competition rules by trade associations.

Negotiations with health insurers, and the Integral Healthcare Agreement

The procurement of health-care services on an individual basis is a cornerstone of the Dutch health-care system. This has also been confirmed in the Integral Healthcare Agreement (IZA), which devotes much attention to collaborations and arrangements that need to be concluded between market participants. Many forms of cooperation are permitted under the competition rules, but the contract negotiations between health-care providers and health insurers must take place on an individual basis.

Also, the implementation of the IZA’s arrangements must take place within the boundaries set by the competition rules. This has been affirmed in various places in the IZA, and ACM has previously already pointed out these passages to market participants, for example within the context of the government’s contribution to the labor-cost development (in Dutch: overheidsbijdrage in de arbeidskostenontwikkeling or OVA). In general, a generic contribution or cost item can be a starting point in negotiations. It will then be up to the individual parties to include it in the negotiations. If trade associations take on a role where they attempt to influence their members, it will lead to higher prices for health insurers, and subsequently to higher premiums for insured. That is why such attempts are prohibited.

What are the next steps?

ACM has sent out requests for information to several trade associations. That information will be assessed over the next few months. ACM will then decide whether it will continue the investigation or terminate it.

ACM and collaborations in health care

Collaborations in the health care sector are vital to keeping health care accessible, affordable, and of high quality. Collaborations can also make health care better and more efficient. That is also one of the objectives of the IZA. ACM supports the objectives for collaborations. As long as collaborations benefit health-care patients, the competition rules will offer room to those collaborations.

See also:

• Collaborations in the health-care sector (in Dutch)