by Professor Jan De Maeseneer, Chair of the Expert Panel on Effective Ways of Investing in Health, Professor in Family Medicine and Primary Health Care, Ghent University, Belgium

Citizens in the European Union expect good quality healthcare, and in fact, it’s been promised to them in the Treaty of the Functioning of the European Union, which states that a high level of human health protection is to be ensured in the definition and implementation of all Union policies and activities and that the EU action should complement national policies and encourage cooperation between Member States in the field of public health while respecting the responsibilities of the Member States for the organisation and delivery of health services and medical care.

So how, in practice, can the Commission help make those ideals realities? Well, in part by relying on expert advice to develop its health policies and assist Member States to make informed, responsible investments in health, so that their health systems are modern, responsible and sustainable.

For this reason, the Commission set up the Expert Panel on effective ways of investing in Health in July 2012, to provide non-binding, scientific advice on matters related to health system modernisation, responsiveness, and sustainability.
The Expert Panel’s area of competence include primary care, hospital care, pharmaceuticals, research and development, disease prevention and health promotion, social protection, cross-border cooperation, health economics and eHealth, and in its first few years of existence has published Opinions (see Focus News) that support health and health care policy making in the EC and the Member States.

Panel members are independent experts from all over Europe with a wealth of combined experience and knowledge in the health care sector. Chosen from a pool of highly qualified experts after an open call for expression of interest, the diversity of the 12 Expert Panel members and their professional and academic achievements makes the Panel an invaluable resource that strengthens the connection between European policy makers and European citizens and helps to transform ideals in a treaty to realities in the lives of people throughout the EU.

In this opinion, the Expert Panel on effective ways of investing in Health (EXPH) addresses the role of competition among health care providers as an instrument to improve efficiency in the use of health system resources. As an instrument, the use of competition among health care providers needs to be measured against the different objectives of health systems. These objectives may be conflicting and require a balance. It is unlikely that competition is aligned with all these objectives at the same time.

The conditions for competition to be a useful instrument vary across countries, health care subsectors and time. There is no golden rule or unique set of conditions that can be met to ensure that competition will always improve the attainment of health systems goals.

Introducing, increasing or changing competition in health services is a delicate policy exercise. The need for an appropriate regulatory framework should be analysed, and relevant institutions and mechanisms be put in place. Accreditation of providers and the detailed design of payment systems are of specific importance. Sound policy evaluation studies are also needed to assess and judge the impact of competition, because policy design and policy outcomes are likely to vary from one context to another. Such evaluation should form the basis for changes in regulation to meet defined policy goals. Key elements to consider when introducing, changing or increasing competition are ensuring market transparency, with availability of information on quality and prices, careful monitoring of access and equity effects, promoting health literacy, and enforcement of competition rules to prevent the creation, strengthening and abuse of dominant positions.
Competition among health care providers is distinct from patient choice.

The value of patient choice has gained important status in several countries as a principle underpinning their health system, and as an instrument for making the allocation of health system resources responsive to patient preferences and enhancing patient empowerment. Patient choice may be combined with different degrees of competition among health care providers; between public providers only, between public and private providers, and with different restrictions for entry to the market. Patient choice works best in situations where patients can easily assess the quality of the services provided. There is a permanent need to build empirical evidence in a way that is useful for policy makers, as context-specific realities will change and with them the effects of introducing or increasing competition among health care providers.

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