Competition policy for health care provision in Portugal

•The role of competition and competition policy in healthcare provision is gaining interest.•The scope for competition among healthcare providers within the Portuguese National Health Service is limited.•The role of “competition for the market” is more relevant than “competition in the market”.

We review the role of competition among healthcare providers in Portugal, which has a public National Health Service (NHS) at the core of the health system. There is little competition among healthcare providers within the NHS. Competition among NHS primary care providers is hindered by excess demand (many residents in Portugal do not have a designated family doctor). Competition among NHS hospitals has been traditionally limited to cases of maximum guaranteed waiting time for surgery being exceeded. The Portuguese Competition Authority enforces competition law. It has focused on mergers between private hospitals and abuse of market power (including cartel cases) by private healthcare providers. The Healthcare Regulation Authority produced several reports on particular areas of activity by private healthcare providers. The main conclusion of these reviews was lack of conditions for effective competition, with the exception of dentistry. Within the NHS, the use of tendering procedures was able to create “competition for the market” in particular areas though it was not problem free. Details in the particular design adopted matter a lot.Overall, the scope for competition policy and for competition among healthcare providers to have a main role in a health system based on a public National Health Service seems limited, with more relevance to “competition for the market” situations than to “competition in the market”.