Private healthcare market investigation

The Competition and Markets Authority (CMA) has completed its remittal into the private healthcare market and has brought article 22 of the 2014 Order into force.

From:
Competition and Markets Authority
Published
7 March 2016
Last updated
12 September 2024 — See all updates
Case type:
Markets
Case state:
Closed
Market sector:
Healthcare and medical equipment
Outcome:
Markets - phase 2 adverse effect on competition leading to remedies
Opened:
4 April 2012
Closed:
28 April 2017

CMA publishes hospital action plans

The CMA has published action plans from hospitals currently in breach of the Private Healthcare Market Investigation Order 2014.

The action plans show the steps the hospitals will take to achieve compliance under the Order. The Order requires hospitals to publish data through the Private Healthcare Information Network (PHIN), to allow consumers to make informed choices.

We published 40 plans on 28 March 2024 and another 30 on 12 September 2024.

Plans published on 12 September 2024

Plans published on 28 March 2024

Further CMA open letter to private healthcare consultants and hospitals

24 July 2023: The Competition and Markets Authority (CMA) has published an open letter to private healthcare consultants and hospitals about their compliance with the Private Healthcare Market Investigation Order 2014.

CMA open letter to private healthcare consultants and hospitals

12 October 2022: The Competition and Markets Authority (CMA) has published an open letter to private healthcare consultants and hospitals about their compliance with the Private Healthcare Market Investigation Order 2014.

CMA approval of PHIN’s Strategic Plan

29 July 2022: The CMA has approved PHIN’s Strategic Plan in accordance with Article 24.1 of the Private Healthcare Market Investigation Order 2014.

Read the full news story for the CAT’s ruling on the private healthcare remittal.

Implementation of article 22 of the 2014 Order

Timetable

Administrative timetable (updated 28.2.17)

Final decision on material change of circumstances

Hearing summary

Responses to decision on material change of circumstances

Provisional decision on material change of circumstances

Responses to notice of intention

Notice of intention

Remedy group appointed

10 October 2016: Following the publication of the final report on private healthcare, the remedy group was appointed on 21 September.

Roger Witcomb (Chairman), Anne Lambert and Tony Morris

Remittal

Timetable

Date of remittal: 12.1.15

Full administrative timetable (updated on 18.7.16)

Contact

Email: general.enquiries@cma.gov.uk

Remittal final report

Responses to remittal supplemental provisional decision on remedies

Remittal provisional decision on remedies

Hearing summaries

As part of its evidence-gathering process, the CMA is holding hearings with a range of industry customers and interested parties.

Responses to the working papers

Responses to remittal provisional decision on remedies

Analysis

Working papers

Summaries of response hearings

Responses to provisional findings and notice of possible remedies

Provisional findings and notice of possible remedies

10 November 2015: The CMA has provisionally found that lack of price competition is harming customers, after re-examining private healthcare in central London.

Evidence

Initial submissions

Responses to invitation to comment and submit further evidence

Notifications

Inquiry remittal group appointed

9 March 2015: The members of the group are:

Roger Witcomb (Chairman), Tony Morris, Anne Lambert, Jeremy Peat, and Jonathan Whiticar.

Phase 2

Date of referral: 04.04.12 Statutory deadline: 03.04.14

Decisions on appeals

Remedies

1 December 2014: The CMA has approved arrangements proposed by the Private Healthcare Information Network (PHIN) to establish an organisation which will provide information on hospitals and consultants for patients via an independent public website.

17 October 2014: The CMA has published notices inviting expressions of interest.

Final order

1 October 2014: The CMA has published a final order following its investigation into the private healthcare market.

Draft orders

8 September 2014: The CMA has published a modified draft order for consultation. This covers the PPU, clinician incentive and information remedies as set out in the final report.

15 July 2014: The CMA is consulting on a draft order covering the PPU, clinician incentive and information remedies as set out in the final report.

Final report

Core documents

Undertakings

The CMA has accepted undertakings given by HCA in relation to the requirement for it to divest either the London Bridge and the Princess Grace hospitals or the Wellington Hospital including the Wellington Hospital Platinum Medical Centre.

Provisional findings report

Date published: 02.09.13

Annotated issues statement

Analysis

Working papers

Surveys

Evidence

Responses to provisional decision on remedies

Summaries of response hearings held with parties

Responses to provisional findings report and notice of possible remedies

BMI

BUPA

Circle

HCA International Limited

Nuffield Health

Ramsay Health Care (UK) Limited

Spire Healthcare

Ulster Independent Clinic

Responses to working papers

Divestment options paper

Empirical analysis methodology of price outcomes in negotiations between hospital operators and insurers

Entry & expansion case studies

Local competition assessment of hospitals of potential concern

Information availability

Price-concentration analysis for self-pay patients

Private Healthcare in central London: horizontal competitive constraints

Profitability

Responses to annotated issues statement

Summaries of hearings held with parties

Responses to issues statement

Initial submissions - Third Parties

Initial submissions - Main Parties

Announcements

News releases

Phase 1

Action

The OFT, in exercise of its powers under Sections 131 and 133 of the Enterprise Act 2002 (the Act) has referred the supply and acquisition of PH in the UK to the Competition Commission for investigation.

Summary of work

The OFT has decided to refer the market for Private Health (PH) to the Competition Commission for a market investigation.

On 8 December 2011, the OFT published a consultation document setting out the provisional decision to refer to the PH market in the UK to the CC and opened a public consultation. The consultation document set out a number of features that the OFT considered, individually or in combination, prevent, restrict or distort competition in this market. We consider that these features of the PH market impair the ability of patients, GPs and PMI providers to choose between competing service providers, including new entrants, on the basis of superior quality of services to patients and better value for money.

The consultation closed on 30 January 2012. Having carefully considered all the comments and evidence received during the consultation, the OFT continues to be of the view that there are a number of features that, individually or in combination, prevent, restrict or distort competition in this market.

The features identified are:

Information asymmetries - the shortage of accessible, standardised and comparable information appears to weaken the ability of patients and GPs to drive efficiencies and stimulate enhanced competition between rival PH facilities and between consultants, and may give rise to a dampening of competition in the market overall.

Concentration - the PH provider market appears to be concentrated at the national level. At the local level there appear to be areas of high concentration, such as areas where there is no alternative fascia PH facility within a 30-minute drive time of a PH facility (solus PH facilities). The existence of solus and PH facilities means that PMI providers appear to be dependent on the PH providers that own these facilities in order to provide local access for their policyholders. The size of the larger PMI providers appears to result in a degree of buyer power. However, their ability to exercise this may be limited.

44% of anaesthetists are part of an Anaesthetist Group (AG). The prevalence of AG groups is also a feature of the market which may reduce price competition in local markets (particularly in view of switching costs such as the costs associated with postponing treatment or travelling to an alternative facility).

Barriers to entry - we consider that a number of features of the PH market combine to create significant barriers to entry. For example, some larger PH providers can impose price rises or set other conditions should a PMI provider recognise a new entrant on its network. There also appear to be direct and indirect incentives given by PH providers to consultants, which could raise those barriers further.

Start date: 10 March 2011, MIR completed 4 April 2012.

Related documents

Press releases

Updates to this page

Published 7 March 2016
Last updated 12 September 2024 + show all updates

  1. Second batch of hospital action plans published.

  2. Hospital action plan responses published

  3. Open letter to private healthcare consultants and hospitals published.

  4. Open letter to private healthcare consultants and hospitals published.

  5. Letter on CMA approval of PHIN’s Strategic Plan published.

  6. Final decision and variation order published.

  7. Hearing summary and submission published.

  8. Responses to decision on material change of circumstances published.

  9. Provisional decision on material change of circumstances and draft order published and timetable updated.

  10. Responses to notice of intention published.

  11. Timetable and notice of intention published and remedy group appointments added.

  12. Full remittal final report published.

  13. Summary of final report published.

  14. Responses to remittal supplemental provisional decision on remedies published.

  15. Timetable updated.

  16. Remittal supplemental provisional decision on remedies published.

  17. Hearing summaries published.

  18. Responses to working papers published.

  19. Response published.

  20. Hearing summary published.

  21. Response to remittal provisional decision on remedies published.

  22. Timetable updated and responses to remittal provisional decision on remedies published.

  23. Working paper published.

  24. Correction to the remittal provisional decision on remedies published.

  25. Remittal provisional decision on remedies report published.

  26. Timetable updated.

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