NERA’s Role in CMA Private Healthcare Market Investigation

Grant Saggers

The Situation

NERA Economic Consulting is pleased to have advised the UK’s largest private medical insurer, Bupa, through the Competition and Markets Authority (CMA) investigation of private healthcare in the UK.

The CMA wanted to make sure that choice and competition were working well for private patients and that the rising costs of healthcare were managed appropriately. The market study and investigation ran over five years and involved evidence gathering from more than 500 stakeholder entities, empirical analysis of millions of patient journeys, and profitability analysis of players across the healthcare system.

Bupa engaged actively and openly with the CMA to make sure the market worked well. 

NERA's Role

In 2011, the Office of Fair Trading (OFC) began its market study into whether the UK private healthcare market was working well for customers. Grant Saggers, then an economist at PricewaterhouseCoopers, was selected as lead economic advisor by Bupa.

The OFT subsequently referred the market into an investigation at the Competition Commission, which became a CMA market investigation when the OFT and Competition Commission merged to form the CMA in 2014.

Saggers continued as lead economic advisor through the various stages of the market investigation and, at the client’s request, after joining NERA as a director. NERA assisted in expert economic advice on: 

  • Market definition for local hospital markets;
  • International benchmarking of doctor pay;
  • Bargaining dynamics between stakeholders (hospitals, doctors, insurers) in the system;
  • Hospital pricing and profitability; and
  • The effects of incentives and information asymmetries.

Saggers gave evidence at five hearings. 

The Result

The CMA concluded its work on the sector in 2016. Its findings recognised the positive role that insurers were playing in controlling healthcare costs. The CMA implemented new information transparency remedies for doctors and hospitals to improve patient choice.