Thus, clear and transparent competition-based decisions in the area of merger between health insurers should be secured by being based on published merger assessment methodology. The enhanced competition among health insurers has constrained prices of hospital services and outpatient prescription drugs. Moreover, competition among hospitals has increased due to the entry of a substantial number of freestanding clinics (ZBCs). Nevertheless, health care spending has increased because of a sharp rise in the volume of care, including in mental health care (Box 1).