Does competition in healthcare harm solidarity?

A one-day workshop organized by the Tilburg Law & Economics Center (TILEC) and Scientific Center for Care and Welfare (Tranzo)

Thursday, 26 January 2012

Corpac House, Tilburg, The Netherlands

On 26 January 2012 the Tilburg Law and Economics Center (TILEC) and Scientific Centre for Care and Welfare (Tranzo) will hold a conference called
'Does competition in healthcare harm solidarity?'.

The one day conference will address this highly topical theme in a multidisciplinary dimension. The focus and audience will be predominantly academic, but policy experts and practitioners will also be present. The theme and the program can be found below.

Does competition in healthcare harm solidarity?

This is a key social and political issue in all developed states wrestling to combine access to healthcare with cost control. In this context introducing competition to enhance efficiency often raises charges of undermining solidarity. In order to answer the question whether competition in healthcare harms solidarity one needs to define solidarity first. Solidarity can be expressed in terms of physical access to health supply for all (spatial solidarity), financial solidarity (income transfers from rich to poor), age solidarity (between old and young) or health solidarity (solidarity from healthy to ill), each with different interactions with competition. Moreover, one could ask whether the extent of solidarity is purely driven by political considerations or whether there is an economic justification to it.

Competition is often associated with the survival of the fittest and hence seems at odds with the notion of solidarity. Solidarity is an important policy goal of healthcare, and hence it seems risky to introduce elements of competition. However, the link between competition and solidarity is not such a straightforward one.

• For instance, competition is also a means of improving efficiency. If waste is reduced, there is more money to go around, and hence, it should be easier to pay for solidarity. Publicly funded systems of free healthcare are often introduced with solidarity in mind, but may play out as less equal than insurance based systems if waiting lists and low quality prompt rich patients to go to the private sector (leading to further degradation of the public system).
• Risk equalisation between health insurers is another example where competition and solidarity are compatible: without evening out the risk profile of the respective insured populations (a solidarity measure) competition on the merits will not arise.
• Finally, there could be tension between solidarity and individual rights (such as the market freedoms in the Treaty on the Function of the EU) and as a result between the EU and national levels. Both aspects introduce interesting legal and social issues.

The questions raised above illustrate why the theme of competition and solidarity in healthcare is of interest to economists, social scientists, legal scholars, practitioners and policy makers. The conference intends to be of practical value as well. It will shed light on the question under which circumstances competition harms or reinforces solidarity. The different ways the interaction between solidarity and competition play out are likely to depend not only on the type of solidarity but also on the segment of healthcare and on institutional choices. Hence the conference also aims to address how to design rules and institutions which enable competition and solidarity to reinforce each other.

Program
Thursday, 26 January 2012
Chair: Prof. Marcel Canoy, TILEC, Tilburg University

9.30-10.00	Registration
10:00-11.30	Session 1: Opening and Keynote Opening: Wouter Bos - former Dutch Minister of Finance, KPMG advisor on Public Sector and Healthcare Keynote: Prof. Martin McKee - Professor of European Public Health, London School of Hygiene and Tropical Medicine
11.30-11.45	Coffee break
11.45-13.15	Session 2: Compatibility between solidarity and competition Speaker: Prof. Carol Propper - University of Bristol Presentation Commentators: Prof. Jan Boone - TILEC, Tilburg University Presentation Prof. Gareth Davies - University of Amsterdam Prof. Johan Polder - TRANZO, Tilburg University Presentation
13.15-14.00	Lunch
14.00-15.45	Session 3: Experiences from other states Speakers: Prof. Erik Schokkaert - University of Leuven , Belgium Presentation Prof. Richard Cookson, University of York Presentation Prof. Konstantin Beck - CSS Institute for Empirical Health Economics, Switzerland Presentation
15.45-16.00	Coffee break
16.00-17.00	Session 4: Policy implications Speakers: Misja Mikkers, Director Strategy and Legal Affairs - Dutch Healthcare Authority (NZa) Prof. Martin McKee - Professor of European Public Health, London School of Hygiene and Tropical Medicine Presentation Prof. Casper van Ewijk - Netherlands Bureau for Economic Policy Analysis
17.00	Closing Reception