1. When the State Becomes the Only Buyer: Monopsony in China’s Public Procurement of Medical Technology
- Author:
- Fredrik Erixon, Oscar Guinea, and Anna Guildea
- Publication Date:
- 03-2022
- Content Type:
- Policy Brief
- Institution:
- European Centre for International Political Economy (ECIPE)
- Abstract:
- China’s centralised state procurement policies are moving the Chinese market of medical technologies in a monopsonistic direction. A monopsony means that a single buyer exerts strong power to move the market to its favour by gradually cutting prices and setting terms for producers that are extortionary. It is equivalent to a monopoly – with the only difference being that in a monopsony, it is the single buyer that acts in a market-predatory manner. Ultimately, a monopsonistic market empowers the buyer to capture most of the financial rewards from a contract. Competition gets undermined because a vibrant market also requires competition between buyers and, over time, fewer firms will be able to supply the procured goods at terms that are set by the single buyer. This shift towards monopsony does not happen overnight, it is a process that builds on a number of steps that tilts the balance of power in favour of the buyer. First, there is a concentration of buyers, sometimes down to a single buyer – such as the state. This concentration of buyers acts to extract value from sellers by creating pressure to reduce and converge prices. Buyers in monopsonistic conditions may also add other objectives to their agenda, using their monopsonistic position to abuse the market. For example, political objectives may be in place, which can include discrimination against foreign companies or corruption. Finally, there is a consolidation of the market, with fewer suppliers overall, and a focus on price rather than innovation. Several characteristics of a market could be indicative of a monopsony. One of these indicators is the price. In the case of the Chinese market for medical technology, price reductions have been sustained across medical devices, with price cuts exceeding 90 percent in some medical products. When the buyer’s primary focus is to reduce prices, the risk is that low-quality products will drive out high-quality products. Another indicator is price convergence: the idea that one price should apply to the whole market. Price convergence can be observed as the distance between the average and maximum price reduction offered by companies. The small differences seen in the Chinese procurement of medical technologies for these two indicators indicates that prices are converging downwards. Forcing a convergence of prices breaks with natural market behaviour and overall leads to a market with fewer participants. In a monopsony, the buyer tends to capture the dominant part of the market value of the product, which squeezes the margins of sellers. Over time, this leads to fewer competitors as only a few companies can survive under such conditions. These dynamics have real consequences: the number of winning companies in the procurement of medical technology per one million people in China is substantially lower than in the EU. In addition to a reduced reliance on multiple suppliers, the Chinese centralised state procurement reinforces China’s industrial policy to support Chinese firms growing their domestic market shares to the detriment of non-Chinese companies. These are the consequences of a market that is increasingly taking a monopsonistic form. Public procurement does not have to follow the Chinese recipe of centralised state procurement. There is a substantial body of evidence, research, and studies that recommend specific procurement policies that tackle the monopsonistic tendencies embedded in public procurement markets. These recommendations emphasize the importance of competition without lowering the number of firms in the market, underlining the need for a long-term view on how the market delivers continuous innovation. The danger for China is that monopsony will collapse the future market by making it less attractive for companies to innovate and compete. Chinese centralised state procurement and the move towards monopsony will not go unnoticed. These policies clearly breach basic principles and norms of international exchange, and how governments should behave to avoid a distortion of competition. First, Chinese centralised state procurement favours the Chinese medical technology industry to the detriment of non-Chinese companies. Second, given the low prices achieved in Chinese centralised state procurements, there is a risk that firm’s margins are severely cut, putting a lid on global spending on R&D. The EU and the US should coordinate their policies to counter the monopsonistic tendencies of the Chinese market of medical technologies. Their markets for medical technologies are significantly larger than the Chinese market and Chinese companies rely on the US and the European market to maintain their growth. The EU-US Trade and Technology Council (TTC) offers a setting to take these discussions forward and agree on policies to counter Chinese market distortions.
- Topic:
- Science and Technology, Health Care Policy, Public Procurement, and Monopsony
- Political Geography:
- China and Asia