Services of general interest provision through the third sector under EU competition law constraints: The example of organising healthcare in England, Wales and the Netherlands

Tensions between ‘Social Europe’ and ‘European economic integration’ have surged at manifold sites, frequently perceived as dissonances between the European economic integration project and social policies at national level. The chapter more specifically approaches this tension by focusing on the situation of third-sector (or not-for-profit) providers of healthcare and the impact of EU competition law as an example of EU hard law. The role of third-sector providers of healthcare differs vastly: while their position is quite established in the Netherlands, in England and Wales they have only more recently established a position in which to compete with traditional public providers. The impact of EU competition law is valued as fundamentally positive as it enables third-sector providers to challenge established market structures or inequitable distribution of state aid. Yet, also some detriment is detected in the adverse position of EU competition law towards co-operative structures and in the chilling effect of state aid rules on cross-subsidising activities. Co-operative structures have a long tradition in the third sector, and cross-subsidising is seen as an instrument to maintain ethical commitment.