Introduction, 
Is Medical Care Different? Old Questions, New Answers, 
Types of Services, 
Reputation, Demand Creation, and the Market for Medical Care, 
Developments in Managed Care, 
Markets in Information, 
Peculiarities in Insurance Markets, 
Conclusion: Is Treating Medical Care the Same as Other Goods a Good Thing?, 
References, 
Competition Among Physicians, Revisited, 
Econometric Studies of Demand Inducement, 
Responses to Fee Controls, 
Other Evidence from Foreign Countries, 
Evidence from Studies of Small Area Variations, 
A Reconsideration of the Demand Inducement Model, 
Conclusion, 
References, 
Has the Erosion of the Medical Marketplace Ended?, 
Results of the Earlier Paper, 
Testing these Results with Additional Data, 
Problems with the Method, 
Other Evidence, 
Conclusions, 
References, 
Competition Among Health Insurers, Revisited, 
Competition in 1977, 
Competition in 1987, 
Why the Change in the Insurance Environment?, 
Competition in 1997, 
References, 
Health Insurance without Provider Influence: The Limits of Cost Containment, 
Cost Containment in Oregon, 
Cost containment in Indiana, 
The Limits of Cost Containment, 
Wickline v. California, 
Conclusion, 
References, 
Managed Competition of Alternative Delivery Systems, 
Managed Competition Defined, 
Market failure, 
Tools Sponsors can Use to Counteract Market Failure, 
Sponsors, 
Conclusion, 
References, 
Halfway Competitive Markets and Ineffective Regulation: The American Health Care System, 
The Limited Effects of Increased Competition in Controlling Medical Care Spending, 
Regulation as a Strategy for Controlling Spending, 
Budget Regulation: An Effective Solution?, 
References, 
Competition in the Market for Nursing Home Care, 
The Market for Nursing Home Care, 
Nursing Home Market Outcomes, 
A Broader View: Efficient Resource Allocation in Long-term Care, 
References, 
Afterword, 
Index, 
Contributors,

CHAPTER 1

Is Medical Care Different? Old Questions, New Answers

Mark V. Pauly

Abstract. This paper examines whether changes in medical markets may be making them more like other markets. The emergence of HMOs and other managed care systems appears to have increased the consumer's potential ability to make better comparative judgments about the price and quality of medical care, and also seems to have made medical care more like other goods. However, the evidence that medical care is a "reputation good" suggests that it is, in this respect, different from other goods. Finally, the social concerns about medical care use necessarily make medical care different.

In answering this rhetorical question a decade ago (Pauly 1978), I tried to distinguish between three kinds of medical care "situations": those for which economic analysis works reasonably well; those for which analysis does not work well; and those for which, under a new competitive framework, analysis might work. Parallel with the question of whether positive economic analysis might explain behavior was the normative question of whether "competition" in some inchoate form might also be feasible and be able to achieve a fair degree of economic efficiency in the various types of medical markets.

My view is that we now have a much clearer understanding of the applicability of economic analysis to different kinds of medical markets, especially to markets for the "potentially competitive" type of service. In contrast to my earlier view, I think both institutional change and the development of new methods of analysis have gone a long way toward filling in the gaps in our ability to apply analysis to medical markets. There is still a good deal left to be learned, but I believe that much of the question of the form and feasibility of competition has been answered. The critical normative question of whether competition can or does produce an efficient outcome also has answers that are surer than they used to be, although there is still considerable room for answering the question posed above with "maybe."

Types of services

In my previous work, my main point of departure was to distinguish these three types of medical services and consider the possibilities for positive and normative analysis of each. Those types were characterized by the frequency of their purchase, the knowledge the typical consumer had about the value of the service in general, and the appropriateness of the service for the consumer's particular problem. The intrinsic characteristic that separated the three types was how much the consumer knew relative to what the seller/provider knew or could know. "Testing" or trying out some medical services (e.g., a hernia repair) was fairly costly. I was beginning to describe what Mark Satterthwaite and I (1981) later called "reputation goods" (or, as I described them ten years ago, goods whose quality is judged by the experience of the consumer's friends). The point we made then was that there are three types of medical services: those that the consumer consumes frequently enough to be able to judge quality and know price (e.g., pediatric office visits for preschoolers); those that the consumer buys infrequently but the provider furnishes commonly, for which a reputation in principle can develop (perfect reputation goods); and those that are rare for everyone and for which, even in the best of circumstances, reputations or track records will be hard to determine (imperfect reputation goods). Indeed, the market for medical care is almost as much a market for information as it is a market for specific services.

I stand by my earlier conjecture that as much as one-fourth of medical care spending occurs in markets when purchases are consumer-initiated and repetitive and when experience is tolerably good. What I think is new is our understanding of what affects the remaining three-fourths of the spending. Here I will comment on four different influences: the development and testing of a theory of reputation as a constraint on or a substitute for demand creation by physicians; developments in the market for health maintenance organizations (HMOs) and other forms of managed care and the attendant reputation effects; the emergence of a market in information on quality and outcomes; and peculiarities in insurance markets.

Reputation, demand creation, and the market for medical care

Once me consumer has initiated a process of formal medical care and begins to obtain information from providers, there will be an opportunity for providers to alter the content of mat advice so as to offset the demand for future services. This phenomenon probably characterizes other kinds of repair services and professional services as well; indeed, it is present to some degree in the advertising or selling efforts which accompany most products. In this sense, if medical care differs from other goods, it is in the relative importance of seller-provided information compared to information gleaned from observing ("searching") the product or experience with the product.

Further development of the theory of reputation goods has indicated that such markets work somewhat differently than the homogeneous good, full information model of competitive equilibrium. In particular, an increase in the number of sellers of reputation goods can lead to an increase in prices. The empirical evidence that Satterthwaite and I examined indicated that this theory did indeed hold in the case of primary care physician services, which were sufficiently subject to out-of-pocket payments to furnish some market effects on pricing. The more recent study by Cromwell and Mitchell (1986) of the pricing of surgical services failed (perhaps not surprisingly) to find similar effects. When there is virtually complete insurance coverage, prices are set by the details of that coverage rather than by the market for care itself.

We also have a clearer theoretical understanding of the limits that a bad reputation can set on the demand creation for reputation goods. Dranove (1983) has developed models which show that demand creation is limited by the negative responses of customers to inaccurate or inappropriate information given by providers. However, we still have no clear empirical understanding of the potential extent of demand creation. There is no doubt that providers could create demand for medical services to a greater extent than would be possible for many other goods. What is not known is whether they will choose to do so, especially in response to changed economic incentives associated with insurer benefit levels and changes in the number of sellers. Nor is it known how much the "tolerably good" services may also be affected by information imperfections. I fear that some part of that marketlike one-fourth of medical care spending may not be so marketlike after all.

For many reasons it is likely that we will never fully resolve the demand creation/information imperfection question. More information will usually (though not always) be better, and other factors (such as the number of sellers and insurer-set price levels) will continue to have potentially perverse effects in the absence of full information. For instance, current proposals to reduce the price of "non-cognitive" physician services (such as surgery) could well lead to an increase in the volume of such procedures in a demand creation model. Thus the fee-for-service market will remain a mystery as far as specific empirical predictions are concerned. But at least we now have a better understanding of why the theoretical ambiguity exists and why it is difficult to resolve empirically.

Developments in managed care

Recent real-world developments in the medical market may show a way out of this impasse (although it may only lead to a different impasse). What I have in mind is the development of various "preferred" and managed care systems, including most HMOs (except some of the independent practice association variety), preferred provider organizations (PPOs), and other systems which manage care in part by measuring the behavior of particular providers. While most of the discussion of (and propaganda for) these systems emphasizes the differences between their provider incentives and those of the fee-for-service system, I believe that this distinction is overdone and that it possibly ignores the more fundamental monitoring and measurement advantages that such systems may have.

In particular, such systems almost by definition encourage the potential purchaser to consider information about the relative frequency of good and bad outcomes—that is, to define quality by outcome. Whether potential HMO enrollees actually do make choices on this basis is not known. There is evidence that HMO members are aware of the limitation on their choice of provider that is embodied in plan membership, but in HMOs (as in other settings) the formal evaluation of quality is only beginning. Nevertheless, it is likely that quality concerns will come to the fore, and it is useful to envision what medical markets would be like when and if such quality concerns do become important.

Part of the motivation for seeking information about quality comes from the practice many HMOs have of using multiple physicians. If a consumer knows he will not have a personal physician (about whose competence he might be able to guess based on the last office visit), he will be eager to obtain information on the track record of the HMO's physicians as a group. And because of the large size of the HMO, the reliability of that information for making judgments will be greater than it could be for any individual fee-for-service physician. As employers become more aggressive proxy shoppers for their employees and as they gather quality and outcome data, purchasers will probably be able to evaluate HMO quality.

In addition, many consumers have been alerted to the "good news/bad news" character of HMO incentives. HMO doctors are not rewarded for unnecessary hospitalization or other use, but they and their firm may gain financially from limiting services. The consumer who sees through the financial incentives in most HMOs may have a legitimate fear of undertreatment, and may seek information to provide evidence that this is not occurring in the HMO he selects.

Finally, the HMO itself has a greater ability to generate and provide reliable information on outcomes than do solo fee-for-service practitioners, since the HMO usually compiles large amounts of internal data for its management and has a marketing obligation to represent itself as being of high quality.

Together, these three factors—need, fear, and opportunity—mean that the ability of the consumer to develop information on the total cost (not just unit cost), outcomes, and quality of the kinds of health care services that represent perfect reputation goods has almost surely improved. Perfection of information will never be achieved—one reason is that perfect information would require prospective HMO enrollees to know the likely outcome for every type of medical event that might occur during the coverage period. However, the information available has certainly improved.

Markets in information

Concomitant with the development of information about HMOs and other managed care arrangements, conventional insurers have shown increased interest in generating their own data on outcomes and use for the claims information they collect. In my original paper, I pinpointed insurers as the most obvious low-cost source of data on these items, but noted that up to that point, timidity and lack of motivation had prevented such efforts from being pursued. At present, there is much discussion of the use of third-party payer data to provide indicators of quality, outcome, or practice style for individual providers, but the only widespread publication of such information has been in the form of Medicare mortality data from a study not intended for public release. Insurers and managed care systems are using such information for internal management purposes, but the major provider of generally available data has been governmental (usually state) data disclosure systems. Since I would judge both the utility and acceptability of insurer-furnished data to be much greater now than it was ten years ago, the failure of such insurer-provided data to become widely available remains puzzling. Judging from the Medicare experience, one reason may be the possibility that information will not be perfectly accurate and the alleged difficulty consumers have in interpreting imperfect data. Another reason may be the "hostility" providers have toward intentionally invidious comparisons.

The development of publicly provided data, the contemporaneous upsurge of interest among professional associations (e.g., the Joint Commission on Accreditation of Hospitals, the American Board of Internal Medicine) in providing outcome-based performance measures, and the emergence of an industry furnishing measures of severity, outcome, and quality are all reasons to suspect that the medical market is on the verge of remedying much of its information deficit.

I hasten to add that this is not the same thing as saying that conclusive information currently exists. What is being suggested here is an improvement on what existed in the past, not a perfection that can never be achieved. As I noted in my earlier paper, not all of the deficit can be remedied, since much of the ignorance about causes and cures is shared by consumers and providers. Nor does anyone expect every consumer to become a medical expert. However, it is clear that information is becoming more available, and that "proxy shoppers" for consumers are emerging to provide the service of digesting and using this information. PPOs, case managers, and employer assistance in prudent purchasing can all be used to provide consumers with the benefits of more information at low subjective cost.

If this movement succeeds, this market may more closely approximate (even in the "rare service" case) both conventional markets and the ideal of perfect competition. However, there are four potential difficulties with this emerging trend that deserve comment.

The first difficulty arises from the heterogeneity of consumers—a heterogeneity that implies that no single standard of care, method of provision, or protocol can be right for everyone. It is therefore inappropriate, and probably harmful, to try to develop a single "Grade A" measure of quality. There is a rationale for setting minimum standards and for limiting access to the market for types of care which no well-informed person would seek, but there is always a danger that minimum standards will become a tool to limit competition. Paradoxically, although the greater availability to consumers and buyers of measures of outcomes ought to make minimum standards less necessary, those measures can also become a tool for further limitation. Here again, there is no change from a fact I noted a decade ago—we hardly have any better idea now than we did then of the degree of heterogeneity of consumer preferences.

The second problem is that the availability of measures of outcomes and quality combined with cost or price information compel consideration of a question many in this market would wish to avoid—the occasional necessity of trading off cost and quality. As Schwartz (1987) has strongly argued, there are some situations in which better outcomes can only be produced by applying more inputs. The cheapest hospital in town may not be the worst, but it is unlikely to be the best; to get better care one would need to pay more.

With the availability of information on cost and quality, the necessity to trade one for the other comes into embarrassing conflict with the rhetoric (shared by benefits managers, HMO marketers, insurers, and politicians alike) that the goal is "the highest possible quality for all." There will be understandable reluctance to publicize decisions to sacrifice quality for cost. The discourse that permits rational discussion of such tradeoffs remains underdeveloped.

The most important advantage to an employee or PPO of an "official" quality measurement system may not be the "truth" of the measurement, but rather the fact that such measures protect a low-cost option from the charge that it is also of low quality. The incentives may then not be to generate a sensitive measure of quality, but instead to target a few bad apples and declare the remainder equally good. Such a situation could correspond with reality, but one should be aware of the incentive to represent the situation in this less threatening fashion, regardless of reality.

(Continues...)

Excerpted from Competition in the Health Care Sector: Ten Years Later by Warren Greenberg. Copyright © 1988 Duke University Press. Excerpted by permission of Duke University Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

"About the title" may belong to another edition of this title.

moluna

Greven, Germany

5-star seller

AbeBooks seller since July 9, 2020

Shipping rates from Germany to U.S.A.

Item	26 to 60 business days	26 to 60 business days
First item	US$ 56.19	US$ 56.19

Delivery times are set by sellers and vary by carrier and location. Orders passing through Customs may face delays and buyers are responsible for any associated duties or fees. Sellers may contact you regarding additional charges to cover any increased costs to ship your items.

Payment methods

Bank Wire Transfer
Check
Paypal

Store description

Online Handel nur mit Neubüchern

Seller's business information

Moluna GmbH

Engberdingdamm 27
Greven, Germany 48268

Contact sellerView this seller's itemsView seller's storefront

Terms of sale

Instructions for revocation/
Standard Business Terms and customer information/ data protection declaration

Revocation right for consumers
(A ‘consumer’ is any natural person who concludes a legal transaction which, to an overwhelming extent, cannot be attributed to either his commercial or independent professional activities.)

Instructions for revocation

Revocation right
You have the right to revoke this contract within one month without specifying any reasons.
The revocation period is one month with effect from the day,

on which you or a third party nominated by you, which is not the carrier, had taken possession of the products, provided you had ordered one or more products within the scope of a standard order and this/these product/products is/are delivered uniformly;
on which you or a third party nominated by you, which is not the carrier, had taken possession of the last product, provided you had ordered several products within the scope of a standard order and these products are delivered separately;
on which you or a third party nominated by you, which is not the carrier, had taken possession of the last part delivery or the last unit, provided you had ordered a product, which is delivered in several part deliveries or units;

In order to exercise your revocation right, you must inform us (Moluna GmbH, Engberdingdamm 27, 48268 Greven, Telephone number: 02571/5 69 89 33, Fax number: 02571/5 69 89 30, E-Mail address: abe@moluna.de) of your decision to revoke this contract by means of a clear declaration (e.g. a letter sent via post, fax or email). You can use the enclosed specimen revocation form for this, which however is not mandatory.

In order to safeguard the revocation period, it is sufficient that you send the notification about the exercise of the revocation right before the expiry of the revocation period.

Consequences of the revocation

If you revoke this contract, we shall repay all the payments, which we received from you, including the delivery costs (with the exception of additional costs, which arise from that fact that you selected a form of delivery other than the most reasonable standard delivery offered by us), immediately and at the latest within 14 days from the day on which we received the notification about the revocation of this contract from you. We use the same means of payment, which you had originally used during the original transaction, for this repayment unless expressly agreed otherwise with you; you will not be charged any fees owing to this repayment.

We can refuse the repayment until the products are returned to us or until you have furnished evidence that you have sent the products back to us, depending on whichever is earlier.

You must return or transfer the products to us immediately and, in any case, at the latest within 14 days with effect from the day on which you inform us of the revocation of this contract. The deadline is maintained if you send the products before the expiry of the 14 day deadline.

You bear the direct costs for returning the products.

You must pay for any depreciation of the products only if this depreciation can be attributed to any handling with you that was not necessary for checking the condition, features and functionality of the products.

Criteria for exclusion or expiry

The revocation right is not available for contracts

for delivery of products, which are not prefabricated and for whose manufacturing an individual selection or stipulation by the consumer is important or which are clearly tailored to the personal requirements of the consumer;
for delivery of products, which can spoil quickly or whose use-by date would be exceeded quickly;
for delivery of alcoholic drinks, whose price was agreed at the time of concluding the contract, which however can be delivered 30 days after the conclusion of the contract at the earliest and whose current value depends on the fluctuations in the market, on which the entrepreneur has no influence;
for delivery of newspapers, periodicals or magazines with the exception of subscription contracts.

The revocation right expires prematurely in case of contracts

for delivery of sealed products, which are not suitable for return for reasons of health protection or hygiene if their seal has been removed after the delivery;
for delivery of products if they have been mixed inseparably with other goods after the delivery, owing to their condition;
for delivery of sound or video recording or computer software in a sealed package if the seal has been removed after the delivery.

Specimen - revocation form

(If you wish to revoke the contract, please fill up this form and send it back to us.)

To Moluna GmbH, Münsterstr. 105, 48268 Greven, Fax number: 02571/5 69 89 30, Email address: abe@moluna.de :
I/we () herewith revoke the contract concluded by me/ us () regarding the purchase of the following products ()/
the provision of the following service ()
Ordered on ()/ received on ()
Name of the consumer(s)
Address of the consumer(s)
Signature of the consumer(s) (only in case of a notification on paper)
Date

(*) Cross out the incorrect option.

Standard Business Terms and customer information / data protection declaration

I. Standard business terms

§ 1 Basic provisions

(1) The following terms and conditions of business apply for all contracts concluded with us as the supplier (Moluna GmbH) via the websites AbeBooks and/or ZVAB. Unless otherwise agreed, the inclusion of your own terms and conditions is explicitly rejected.

(2) A ‘consumer’ in the sense of the following regulations is every natural person who concludes a legal transaction which, to an overwhelming extent, cannot be attributed to either his commercial or independent professional activities. The term ‘businessman’ refers to every natural person, legal person or legally responsible partnership that concludes a legal transaction in pursuance of his/its independent professional or commercial activity.

§ 2 Conclusion of the contract

(1) The subject-matter of the contract is the selling of products .

(2) If an article is placed by us with AbeBooks or ZVAB, the activation of the page on AbeBooks or ZVAB shall involve the binding offer to conclude a contract under the terms and conditions contained in the article page.

(3) The contract shall become effective via the online shopping cart system as follows:
The products intended for purchase are moved to the "shopping cart". You can select the "Shopping Cart" using the appropriate buttons on the navigation bar and make changes there at any time.
After calling up the “Checkout” page and entering the required personal data and payment and shipping conditions, all order information is then displayed again on the order summary page.
Before submitting the order, you have the ability once more to review or change any information here (you may also use the "back" button on the Internet browser), or to cancel the purchase.
By clicking the “Buy now” button to submit the order, you declare your legally binding acceptance of the order which makes the contract effective.

(4) The execution of the order and the sending of all the details necessitated by the conclusion of the contract take place via e-mail, in a partially-automated manner. Consequently, you have to ensure that the e-mail address that you have deposited with us is the correct one, and that the receipt of the respective e-mails is guaranteed. In particular, you have to ensure that the respective e-mails are not blocked by a SPAM filter.

§ 3 Right of retention, reservation of proprietary rights

(1) You can only exercise a right of retention if the situation in question involves claims arising from the same contractual relationship.

(2) The goods remain our property until the purchase price is paid in full.

(3) If you are a businessman, the following conditions also apply:

a) We retain ownership of the goods until all the claims arising from the ongoing business relationship have been settled in full. The goods subject to retention of title may not be pledged or transferred by way of security before ownership of the said goods changes hands.

b) You can re-sell the goods within the framework of an orderly transaction. In this regard, you hereby cede all the claims amounting to the magnitude of the billing amount that accrue to you as a result of the re-selling operation to us, and we accept the cession. Furthermore, you are authorised to collect the claim in question. However, insofar as you do not discharge your payment obligations in an orderly fashion, we reserve the right to collect the claim ourselves.

c) In a situation involving the combination and amalgamation of the goods subject to retention of title, we acquire co-ownership of the newly-formed item. This co-ownership corresponds to the ratio that exists between the invoice value of the goods subject to retention of title and the other processed items at the time of processing.

d) If you make a request of this nature, we shall be obligated to release the securities that are due to us, to the extent that the realisable value of our securities exceeds the claim to be secured by more than 10%. We are responsible for selecting the securities to be released.

§ 4 Warranty

(1) The statutory warranty rights are applicable.

(2) As a consumer, you are requested to promptly check the product for completeness, visible defects and transport damage as soon as it is delivered, and promptly disclose your complaints to us and the shipping company in writing. Even if you do not comply with this request, it shall have no effect on your legal warranty claims.

(3) If a characteristic of the goods deviates from the objective requirements, the deviation shall only be deemed to be agreed if you were informed of the same by us before submitting the contractual declaration and the deviation was expressly and separately agreed between the contracting parties.

(4)
Insofar as you are an entrepreneur, the following shall apply in deviation from the above warranty provisions:

a) Only our own specifications and the manufacturer's product description shall be deemed agreed as the quality of the goods, but not other advertising, public promotions and statements by the manufacturer.

b) In the event of defects, we shall, at our discretion, provide warranty by rectification of the defect or subsequent delivery. If the rectification of defects fails, you may, at your option, demand a reduction in price or withdraw from the contract. The rectification of defects shall be deemed to have failed after a second unsuccessful attempt, unless the nature of the goods or the defect or other circumstances indicate otherwise. In the event of rectification of defects, we shall not be obliged to bear the increased costs arising from the transport of the goods to a place other than the place of performance, unless such transport is in accordance with the intended use of the goods.

c) The warranty period shall be one year from delivery of the goods. The shortening of the period shall not apply

for culpable damage attributable to us arising from injury to life, limb or health and for other damage caused intentionally or by gross negligence;
insofar as we have fraudulently concealed the defect or have assumed a guarantee for the quality of the item;
in the case of items which have been used for a building in accordance with their customary use and have caused its defectiveness;
in the case of statutory rights of recourse that you may assert against us in connection with rights arising from defects.

§ 5 Choice of law, place of fulfilment, jurisdiction

(1) German law shall apply. This choice of law only applies to customers if it does not result in the revocation of the protection guaranteed by the mandatory provisions of the law of the country in which the respective customer’s usual place of residence is located (benefit-of-the-doubt principle).

(2) If you are not a consumer, but a businessman, a legal entity under public law or an institutional fund governed by public law, our place of business is the place of jurisdiction as well as the place of fulfilment for all services that follow from the business relationships that exist with us. The same condition applies to situations in which you are not associated with a general place of jurisdiction in Germany or the EU, as well as situations in which the place of residence or the usual place of residence is not known at the time of commencement of proceedings. This has no bearing on the capacity to call upon the court associated with another place of jurisdiction.

(3) The provisions of the UN Convention on Contracts for the International Sale of Goods are explicitly inapplicable.

II. Customer information

Identity of the seller

Moluna GmbH
Engberdingdamm 27
48268 Greven
Germany
Telephone: 02571/5698933
E-Mail: abe@moluna.de

Information regarding the conclusion of the contract

The technical steps associated with the conclusion of the contract, the contract conclusion itself and the correction options are executed in accordance to the regulations "conclusion of the contract" in our standard business terms (part I.).

Contractual language, saving the text of the contract

3.1 Contract language shall be English.

3.2 The complete text of the contract is not saved with us. Before the order is sent, the contract data can be printed out or electronically saved using the browser’s print function. After the order is received by us, the order data, the legally-mandated details related to distance selling contracts and the standard business terms are re-sent to you via e-mail.

Main features of the product or service

The key features of the goods and/or services can be found in the respective quote.

Prices and payment arrangements

5.1 The prices mentioned in the respective offers represent total prices, as do the shipping costs. They include all the price components, including all the incidental taxes.

5.2 The dispatch costs that are incurred are not included in the purchase price. They can be viewed by clicking the appropriate button on our website or in the respective quote, are shown separately over the course of the order transaction and must additionally be borne by you, insofar as free delivery is not confirmed.

5.3 The payment methods that are available to you are shown by clicking the appropriate button on our website or are disclosed in the respective quote.

5.4 Unless otherwise specified for the respective payment methods, the payment claims arising from the contract that has been concluded become payable immediately.

Delivery conditions

6.1 The delivery conditions, delivery date and existing supply restrictions, if applicable, can be found by clicking the appropriate button on our website or in the respective quote.

Unless a different period is specified in the item description or our delivery conditions, the goods are delivered within 3-5 days after the conclusion of the contract (in case an advance payment has been agreed upon, after the payment authorisation).

6.2 If you are a consumer, the following is statutorily regulated: The risk of the sold item accidentally being destroyed or degraded during shipping only passes over to you when the item in question is delivered, regardless of whether or not the shipping operation is insured. This condition does not apply if you have independently commissioned a transport company that has not been specified by us or a person who has otherwise been appointed to execute the shipping operation.

If you are a businessman, the delivery and shipping operations take place at your own risk.

Statutory warranty right

Liability for defects is governed by the “Warranty” provisions in our General Terms and Conditions of Business (Part I).

last update: 01.01.2022

Data protection declaration

Unless stated otherwise below, the provision of your personal data is neither legally nor contractually obligatory, nor required for conclusion of a contract. You are not obliged to provide your data. Not providing it will have no consequences. This only applies as long as the processing procedures below do not state otherwise.
“Personal data” is any information relating to an identified or identifiable natural person.

Responsible person
Contact us at any time. The contact details of the person responsible for data processing can be found in our legal notice.

Collection, processing, and transfer of personal data in orders
When you submit an order we only collect and use your personal data insofar as this is necessary for the fulfilment and handling of your order as well as processing of your queries. The provision of data is necessary for conclusion of a contract. Failure to provide it will prevent the conclusion of any contract. The processing will occur on the basis of Article 6(1) b) GDPR and is required for the fulfilment of a contract with you.
Your data is transferred here for example to the shipping companies and dropshipping providers, payment service providers, service providers for handling the order and IT service providers that you have selected. We will comply strictly with legal requirements in every case. The scope of data transmission is restricted to a minimum.

Duration of storage
After contractual processing has been completed, the data is initially stored for the duration of the warranty period, then in accordance with the retention periods prescribed by law, especially tax and commercial law, and then deleted after the period has elapsed, unless you have agreed to further processing and use.

Rights of the affected person
If the legal requirements are fulfilled, you have the following rights according to art. 15 to 20 GDPR: Right to information, correction, deletion, restriction of processing, data portability. You also have a right of objection against processing based on art. 6 (1) GDPR, and to processing for the purposes of direct marketing, according to art. 21 (1) GDPR.

Right to complain to the regulatory authority
You have the right to complain to the regulatory authority according to art. 77 GDPR if you believe that your data is not being processed legally.

Right to object
If the data processing outlined here is based on our legitimate interests in accordance with Article 6(1)f) GDPR, you have the right for reasons arising from your particular situation to object at any time to the processing of your data with future effect.
If the objection is successful, we will no longer process the personal data, unless we can demonstrate compelling legitimate grounds for the processing that outweigh your interests or rights and freedoms, or the processing is intended for the assertion, exercise or defence of legal claims.

last update: 10.01.2022

Competition in the Health Care Sector: Ten Years Later

Bibliographic details

Synopsis

About the title

Excerpt. © Reprinted by permission. All rights reserved.