Back in 2010 only 20% of States (globally) enacted price-setting regulations or competition laws for ANS, according to an ICAO survey.
In Europe, there are pockets of competition for ATC, but this is mostly restricted to aerodrome and approach services. Germany and Spain have both launched competition for 10 or so of their airports. In Scandinavia, Sweden has competed most airports except for the biggest; Norway has started competing airport ATC, and is considering more. The UK is the country with the most aerodrome services competed.
When it comes to enroute services, we are some way off seeing the introduction of competition. However, the upper airspace over Kosovo (operated by Hungarocontrol since 2014) provides an interesting case study, and some ANSPs we've talked to think that 5-10 years from now we could see enroute services being competed. But for now, it is still rare.
Why does this matter? Well it results in a limited incentive to innovate or improve efficiency – competition is an acknowledged driver of innovation and efficiency. It also means that customers (the airports) have little say in how services are provided and at what cost, leaving those with insufficient movements to cover their costs reliant on subsidies. Who pays the subsides? Typically, the airport owner, or the taxpayer. So, monopoly matters because it probably costs us more, and gives us less
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