In the Dutch healthcare system, provider competition is used as a tool to improve efficiency. From a competition policy perspective, little is known about how collaboration among healthcare providers contributes to overall patient welfare, and how a balance is achieved between scale benefits and preventing anticompetitive collusion. This paper examines the ex-post effects of a Dutch case study in which three competing hospitals have collaborated to provide highcomplexity low-volume cancer surgery, an arrangement that tests the limits of permissibility under the Dutch cartel prohibition. Our preliminary empirical research demonstrated only a modest increase in price and travel time for some of the tumour surgeries. Volume analysis showed that the intended centralization of surgical procedures has not been fully realized. Our findings highlight the importance of a comprehensive self-assessment by the collaborating hospitals to ex-ante assess (potential) efficiencies and antitrust risks. Such self-assessments could benefit from research focused on which collaborations are most appropriate to achieve quality gains. For the ex-post assessment by competition authorities following the cartel prohibition, a more thorough insight into the (long-term) changes in hospital prices, profitability, and quality after collaboration is needed.

中文翻译：

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基于市场的医院系统中的合作与竞争政策：来自荷兰的案例研究

在荷兰的医疗保健系统中，提供者竞争被用作提高效率的工具。从竞争政策的角度来看，对于医疗保健提供者之间的协作如何为整体患者的福利做出贡献，以及如何在规模效益和防止反竞争勾结之间取得平衡，鲜为人知。本文研究了荷兰案例研究的事后效果，在该案例中，三家相互竞争的医院合作提供高复杂性，小批量的癌症手术，这种安排可以测试荷兰卡特尔禁止下的可容许性极限。我们的初步经验研究表明，某些肿瘤手术的价格和旅行时间仅适度增加。容量分析显示，尚未完全实现手术程序的预期集中化。我们的研究结果突显了合作医院进行全面自我评估以事前评估（潜在）效率和反托拉斯风险的重要性。这样的自我评估可以受益于针对哪种合作最适合实现质量提升的研究。为了禁止卡特尔竞争管理机构对事后进行事后评估，需要更深入地了解合作后医院价格（利润）和质量的（长期）变化。