On Tuesday the 26th of October 2021, the scheduled teleconference / consultation of the Competition Commission which was organized in the context of the sector inquiry on Health & Private Insurance Services, was successfully held. The tele-consultation followed the submission of written memoranda by interested companies and organizations and was designed with the prospect of functioning as an interactive forum for the exchange of views on the markets in question. The tele-consultation, which took place through a privately owned livestreaming studio in FULL HD quality, forms part of the overall framework of the Competition Commission's digital communication reform, based on which the Commission aspires to develop more direct contact with both businesses, consumers and citizens for the benefit of the Greek’s Economy development.
The teleconference was watched on live stream through the Competition Commission’s platform by many stakeholders, including companies, associations of enterprises, lawyers and economists working in the field of competition, as well as, academics, social stakeholders and consumers associations.
During the event, which was opened by the President of the Competition Commission, prominent academics and representatives of the market made presentations on a wide range of current issues of competition law and economics. In particular, the tele-consultation was structured in four thematic sessions, a) HEALTH SECTOR AND COMPETITION LAW, b) HEALTH INSURANCE AND COMPETITION LAW, c) CONVERGENCE BETWEEN HEALTH AND INSURANCE SECTORS AND NEW TECHNOLOGIES: CHALLENGES TO COMPETITION LAW and d) REGULATORY BARRIERS AND THE ROLE OF THE STATE IN THE PROMOTION OF COMPETITON AND INNOVATION WITHIN THE SECTOR OF PRIVATE HEALTH AND INSURANCE.
In particular, in the context of the first session, the current market and competition conditions in the health services sector were analyzed. It was noted that Greece has witnessed twelve consecutive years of crisis; as the ten years of economic crisis were followed by the two years of the pandemic crisis. However, it was argued that the Greek economy now seems to be recovering and consists a pole of attraction for interested investors, while, at the same time, it appears that necessary conditions for further mergers and acquisitions are being created. According to the views expressed, the public and private health sectors do not constitute direct competitors in terms of the offered health services. It was also noted that transactions on share capital of health providers[1] are taking place, especially in the region of Attica, with high horizontal (and not only) concentration levels. The crucial importance of prudential control by the competition authorities is therefore confirmed, while the dynamics of the sector should be taken into account (in order to successfully address issues such as asymmetric information, barriers to entry, etc.), with the ultimate goal of achieving competitive prices, quality of services and a sufficient number of alternative providers, i.e. social welfare. Also, the transparency of procedures and good practices was addressed, with emphasis on the issue of doctors' civil liability and the duration of their insurance coverageas well as the need to differentiate insurance coverage limits in relation with the specialization of the doctor. The issue of access to health data and the possibility that such access may lead to discrimination against citizens / patients, resulting in limited access to health services for them and, at the same time, to a reduction of competition and an increase in the market powers of those companies that gain access to this data were analyzed with relevant examples (e.g., mergers of insurance companies with pharmacy chains). Among other things, it has been expressed the position that the sector inquiry should also extend to public health services. At the same time, reference was made to costs as the main barrier to entry into private care and the role that competition law could play, inter alia, in the allocation of health resources. In the same context, it was proposed that the subject of the sector inquiry should cover the possibility of altering the regulatory framework concerning private clinics, as well as the issue of rebate & clawback.
The second session discussed the topic "Private Health Insurance: products, competition and relationships with private health care providers" and highlighted, among other things, the strict regulatory framework that governs the insurance market in general, while it was mentioned that the main reason behind the mergers in this market is the need for companies to become stronger in terms of capital and more competitive. The topic "The implementation of competition rules in health insurance" was also presented. In this context, among other things, the special importance of the exchange of information for the proper assessment of the risks inherent in insurance as well as the balancing role of insurance companies for the relationship between patient / insured and health care provider was highlighted. In addition, during the presentation of the topic "Health insurance in 2021: Challenges & Developments" was pointed out the fact that diseases change and so does the evolution of medical science (at medical and technological level) and that the way the insurance coverage is affected due to the aging population. In Greece, the insurance coverage is characterized by overlap and double payment and, for this reason, it was proposed that the health system should be made complementary (instead of optional as it is today). The specific panel closed with the presentation of "Private Health Insurance: The competitiveness of the industry and its relations with health suppliers", which highlighted, among other things, the significant number of players in the relevant market, while emphasizing the specificity of configuration of the insurance costs of health products, as long as, the importance of DRGs.
The topic of the third panel was "Digitization in the Health & Life Sciences and the Transformation of Value Chains: Legal and regulatory perspectives" and linked the ambitions and opportunities in the fields of health and life sciences, created by new technologies, with the field of law and, in particular, with competition law (either through the facilitation of collaborations or through interventions in cases of collusion, wherever this is required). The topic “AI-driven decision system for de-risking drug development and enabling external innovation. Health data and insurance” was also presented from the perspective of an innovative company that has the mission, by assessing the relevant risk, to help patients receive a new treatment faster and more effectively through the application of scientific data in the development of drugs. Finally, on the same panel the topic "Data pooling, data ownership, health, human medicine and Competition Law" was presented, with emphasis given mainly on the possibility in both theory and practice to turn all internet-related activities into data that can be collected, as the new data can now be considered as new "fuels". The expressed idea was, among other things, that the so-called data pools could constitute the means for small companies to offset their disadvantage in terms of data accessibility (consumer, technological, clinical, etc.).
In the fourth and final panel, the topic "Health services, insurance and competition law: the English experience" was presented, with an emphasis on how health care providers in the UK are organized and how they are interconnected (the state plays a central role, while at the same time there are non-profit providers and vice versa), where state aid is a key issue. On the same panel the special topic "Organization and Operation of Health Units", was elaborated having as a main pillar the establishment of the National Health System and the operation of hospitals, given their internal Organization. Finally, the topic “Innovation and competition in healthcare; three NL examples” discussed the Dutch health system, which is mainly private, and analyzed three collaboration case studies related to a) the treatment of various types of cancer, b) seeking a combination of a step by step approach and c) the necessary legal certainty (as a condition for investments).
In the next phase of the sector enquire, the HCC will send informational requests (questionnaires) to public and private bodies and, after the analysis and evaluation of all the information, will draft an interim report. A second public consultation will then take place and the final report will be published.
You can watch the video of the tele-consultation on the website of the Hellenic Competition Commission (mostly in Greek) here or on the YouTube channel of the HCC.
[1] Along with insurance companies.
