Competition in the Health Sector
BOS 1 - Beyond price in healthcare markets: Access, quality and equity
Luigi Siciliani
University of York
1 December 2025
Global Forum on Competition, OECD, Paris
Equity
• Rural areas: facilitate entry, health workforce issues
• Inequalities: effect of competition, which dimensions?
• Postcode lottery (geographic disparities)
• Socioeconomic inequalities
• Ethnicity
• Health, healthcare, quality, access, waiting, out of pocket payments
• Recent analytical frameworks: distributional cost-effectiveness analysis
• Estimates of inequality aversion (Robson et al, 2024) to compare health distributions
• Can be used for assessment of pay for performance or other schemes (Siciliani et al, 2025)
• Effect of competition on waiting time inequalities (Moscelli et al, 2024, J Eco Beh & Org)
Access, quality, non-price attributes and prices
• Private health insurance
• Mergers, networks, integration with healthcare providers
• Interface with public health insurance
• Longer waiting times after COVID-19, access more difficult
• Integration between primary and secondary care providers
• Networks could improve coordination of care but increase market power
• Hospitals or insurance mergers
• Effect on quality and access
• Remit of antitrust authorities
Access, quality, non-price attributes and prices
• Nursing homes, care homes, home care, rehabilitation, dental care
• Prices not fixed in many countries!
• Competition should lower prices
• effect on quality a priori unclear (direct vs indirect effect through prices)
• Public procurement
• How to include non-price attributes (e.g. quality, superior technology)?
• How to weight higher quality versus higher price when comparing bids? Is it working?
• Can we include environmental considerations (e.g. emissions)? In principle, yes
• Pharmacies: facilitate entry