Ilaria Mosca is Assistant Professor, Institute of Health Policy & Management (iBMG), Erasmus University Rotterdam, The Netherlands.
Email:mosca@bmg.eur.nl
I 7
EVALUATING
REFORMS IN THE NETHERLANDS )
COMPETITIVE HEALTH INSURANCE SYSTEM
By: Ilaria Mosca
Summary: The 2006 health care reform in the Netherlands
attracted widespread international interest in the impact of regulated competition on key factors such as prices, quality, and volume of care.
This article reviews evidence on the performance of the health care system six years after the reform: health care costs have kept growing;
quality information has become readily available; hospital efficiency has improved on an annual basis; and consumers have had greater choice. The transition to regulated competition is a gradual process.
The full effects may not become evident until sometime in the future.
Looking forward, monitoring the health care system is an important prerequisite to better understand the effects of regulated competition in health care.
Keywords: Regulated Competition, Health Care Expenditure, Consumer Choice, Efficiency, Quality
The health care reform implemented in the Netherlands in 2006 has attracted extensive international interest,
particularly on how regulated competition impacts on key factors such as prices, quality, and volume of care. This reform was carried out as a response to policy concerns about accessibility to health services, quality of care, rising health care costs and waiting lists that emerged in the 1990s. Several steps were taken from 1990 that ultimately led to the 2006 reform. These included: eliminating the
regional monopolies of sickness funds (1992); developing a risk equalisation system (1992); allowing consumers to switch insurer once a year instead of once every two years (1996); introducing a bundled hospital payments system -Diagnosis Treatment Combinations (DTCs, a Dutch variant of DRGs) (2005);
and partly deregulating price and capacity control (2005-2006).
In 2006, health care changed from a dual system of mandatory public insurance and
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