Estonian Competition Authority
On 15 January governments of Järva and Jõgeva counties submitted to the Estonian Competition Authority the joint request to conduct supervision and investigate circumstances of the so-called “ambulance tender”. In the process of the investigation the Estonian Competition Authority did not discover any violations of the Competition Act.
Since 1 January 2014 the Health Board has decided to significantly reduce the number of service regions and make new service regions much larger than the current ones. In order to find providers of ambulance services for the new regions the tender was announced. Before the announcement, the Union of Estonian Providers of Ambulance Services that includes the major ambulance service providers has submitted to the Health Board the proposal regarding the tender conditions, according to which the major ambulance service providers were to receive a significant preference. Governments of Järva and Jõgeva counties asked the Estonian Competition Authority to investigate circumstances of the said tender.
According to the assessment provided by the Estonian Competition Authority, the offer made by the Union of Estonian Providers of Ambulance Services is an example of one interest group’s lobbying in connection with the Health Board. The Competition Act does not prohibit unions of companies to make proposals with regard to tender conditions. The Estonian Competition Authority also notes that professional unions as far as possible consider in their activity interests of all parties involved, including those of patients and other service providers. Having compared the proposal of the Union of Estonian Providers of Ambulance Services and the actual tender conditions approved by the Health Board, the Estonian Competition Authority finds that they are different a large extent and thus it is impossible to claim that the Health Board was noticeably influenced by the offer of the Union of Estonian Providers of Ambulance Services.
While the conditions of the ambulance tender approved by the Health Board contain several provisions (primarily with regard to enlargement of service regions) that, at the first glance, may appear as creating preferences for larger companies, in fact these conditions are related to the planned ambulance reform. The ambulance reform, including the decrease of the number of service regions, is, in turn, a health policy choice.
The Estonian Competition Authority notes that the ten ambulance service regions cannot be considered an excessively low number from the point of view of competition, and that it is worth mentioning that the Health Board has provided for the conditions aimed at avoiding excessive market concentration. For instance, according to the tender conditions, every applicant has the right to apply for up to two service regions.