Healthcare, Quality Concerns and Competition Law

Market driven healthcare is massively divisive. Opponents argue that a competition approach to medical treatment negatively impacts on quality, while advocates point to increased efficiencies. This book casts a critical eye over both positions to show that the concerns over quality are in fact real. Taking a two part approach, it unveils the fault lines along which healthcare provision and the pursuit of quality would in certain cases clash. It then shows how competition authorities can only effectively assess competition concerns when they ask the fundamental question of how the concept of healthcare quality should be defined and factored into their decisions. Drawing on UK, US and EU examples, it explores antitrust and merger cases in hospital, medical and health insurance markets to give an accurate depiction of the reality and challenges of regulating competition in healthcare provision.

Theodosia Stavroulaki is Assistant Professor of Law at Gonzaga University School of Law, USA. Her teaching and research interests include antitrust, health law, and law and inequality. Before joining Gonzaga University Theodosia served as a Jaharis Faculty Fellow at the DePaul College of Law, Grotius Research Scholar at Michigan University School of Law, and Hauser Global Fellow at NYU School of Law. She also served as a visiting researcher at Georgetown Law School and at the London School of Economics. Her scholarship has been published in the Journal of Competition Law & Economics, Berkeley Business Law Journal, World Competition, Loyola Consumer Law Review and the American Journal of Law & Medicine. Theodosia's article, 'Mergers that Harm Our Health', (2022)19 Berkeley Bus LJ, was nominated for the Best Academic Article (mergers category) in the 2021 Concurrences Antitrust Writing Awards organized by George Washington University and the journal Concurrences. Theodosia's forthcoming book, Healthcare, Quality Concerns and Competition Law: A Systematic Approach (Hart Publishing) explores how health care quality concerns are considered by competition authorities on both sides of the Atlantic. Theodosia's research has been funded by a number of prestigious institutions including the American Bar Association Section of Antitrust Law, the Fulbright Commission, NYU School of Law, Michigan Law School, European University Institute, Tel Aviv University, the European Commission, the Greek Scholarships Foundation and the Greek Association of Law and Economics. Before commencing her academic career, Theodosia worked as an antitrust associate in a leading law firm in Greece, where she advised multinational firms in a broad range of antitrust and business issues, and a lawyer at the Policy Unit of DG Competition of the European Commission. Theodosia holds a PhD in antitrust law from the European University Institute.

1. Setting the Scene: What is Healthcare Quality?
I. How is Healthcare Quality Defined
II. Deconstructing the Notion: What are the Main Dimensions of Healthcare Quality?
III. Choosing the Core Dimensions of Healthcare Quality: Why is it Essential?
IV. Levels of Analysis in the Concept of Quality
V. How is Healthcare Quality Measured?
VI. Structure, Process and Outcome: When to Use What?
VII. Summing Up
2. Introducing Competition in Healthcare: What are the Risks to Healthcare Quality?
I. Towards the Marketisation of EU Health Systems: What is the Rationale Behind this Trend?
II. Is the Market for Healthcare Special?
III. Applying Competition Law with a View to Protecting Healthcare Quality: What are the Challenges?
IV. Summing Up
3. The Market Approach: Part I
I. Professionalism versus Antitrust: What is the Debate About?
II. Do the US Antitrust Enforcers and the Courts Take into Account Healthcare Quality?
III. Do the US Antitrust Enforcers and the Courts Balance Conflicts Between Different Quality Perspectives?
IV. Summing Up
4. The Market Approach: Part II
I. How are Hospitals Paid? A Historical Perspective
II. Hospital Merger Analysis: A Short Journey to the Applicable Competition Framework
III. Quality in the US Hospital Merger Analysis
IV. Incorporating Healthcare Quality Claims into a Merger Analysis: A Mission Impossible?
V. Summing Up
5. The Holistic Approach
I. Health Systems in Europe: What are their Common Values and Objectives?
II. Conflicts between the Goals of Competition and the Multiple Facets of Healthcare Quality: Reflections on the English Health System
III. Protecting Healthcare Quality under EU Competition Law
IV. How can Healthcare Quality be Evaluated as a Whole?
V. Summing Up
6. The Regulatory Approach
I. An Introduction to the Main Facets of the HSCA 2012: How Does this Framework Force Hospitals to Merge?
II. How and to What Extent Does the CMA Integrate Quality Concerns in the Context of NHS Mergers?
III. Evaluating the CMA's Approach as a Whole: What are the Aspects of Quality the CMA Considers in its Merger Assessment?
IV. Summing Up
7. Reflections
I. The Book's Core Findings
II. Integrating Healthcare Quality as a Whole: Mission Impossible?
III. Looking Towards the Future: Antitrust in the Era of Data Driven Mergers in the Healthcare Field