The practices were related to the Portuguese market for the provision of private hospital health services by health subsystems. These practices also directly impacted (add full name) (IASFA), another health subsystem used by Portugal’s armed forces. The IASFA is indexed on ADSE’s price table and rules. For five years, from 2014 to 2019, six healthcare companies and groups of hospitals coordinated their strategy in the negotiations with ADSE, with the clear objectives of fixing price levels and other commercial terms and coordinating several threats of termination of the agreement with ADSE.

The entities harmed by the practices were be the ADSE, i.e., the public health sub-system, and its beneficiaries. Indeed, the limited access to health services provided by public sub-systems forced patients in need of complementary services (i.e. not provided by the SNS) to resort to private health systems. The illegal conduct also affected the competitors of the defendants, who acted in concert. The decision indicated that there was an average upward trend in billing under the ADSE agreement equal to 5% per year. For IASFA, the trend was an average growth of 4% per year. The volume of trade affected during the cartel period is estimated at EUR 2.37 billion (based on the figures provided in the decision). If 5% of this amount was due to the infringement, the damage could amount to EUR 118.5 million.