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Mary Guy, Competition Policy in Healthcare: Frontiers in Insurance-Based and Taxation-Funded Systems

Document Cited in Related
Vincent
Date01 January 2020
DOI10.3366/elr.2020.0615
Pages154-156
Published date01 January 2020

In popular discourse in European contexts, and certainly in the UK, the idea that healthcare should be subject to the rules that apply to ordinary markets is highly controversial. For example, in early June 2019, President Trump's state visit to the UK was accompanied by extremely critical news reports to the effect that Trump is seeking to use a post-Brexit UK-US trade deal to “open up the NHS” to American firms. “Hands off our NHS” is the common message associated with these kinds of sentiments.

If, like me, you are regularly infuriated by the imprecision of broad-brush sentiments like these, Mary Guy's book will come as a delight. Its starting point is that it is more complicated than “keep the market out of healthcare” versus “we need the market to make healthcare efficient”. There is a world of difference between competition between, for instance, global pharmaceutical companies supplying NHS hospitals and pharmacies, where patients rely on free or heavily subsidised NHS prescriptions; and competition between independent physicians, or privately-owned companies, supplying long-term care, or emergency health services, to patients or to the social insurance entities with whom they are insured. There is also a world of difference between looking at demand-side factors (like the number of providers and the availability of transparent information on services or products provided); supply-side factors (like barriers to entry to a market, for instance because of technology access); and institutional factors (like the formal legal forms of ownership of entities, including private capital, public/private initiatives, (re-)nationalisation). And there is a world of difference between the specificities of how competition could, and does, apply within different health systems. In order to understand the implications, we need granular analysis, of actual healthcare systems, and the (competition) law that applies to them. That is what this book provides.

At the heart of the book is a carefully justified, rigorous and thorough analysis of the detailed rules of the two European healthcare systems that have gone the furthest in embracing competition law: the Netherlands and England. Guy is careful to distinguish the English NHS from the rest of the UK: Scotland, for instance, has not adopted the approach discussed here. The reader is treated to a historical and contemporary account which puts the reforms of the Dutch and English health systems, and the legislative...

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