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Effects of purchaser competition in the Dutch health system: is the glass half full or half empty?

Published online by Cambridge University Press:  26 January 2011

Frederik T. Schut  and
Wynand P. M. M. van de Ven
Frederik T. Schut*
Affiliation:
Professor of Health Economics, Institute for Health Policy and Management, Erasmus University Rotterdam, The Netherlands
Wynand P. M. M. van de Ven
Affiliation:
Professor of Health Insurance, Institute for Health Policy and Management, Erasmus University Rotterdam, The Netherlands
*
Correspondence to: Frederik T. Schut, Professor of Health Economics, Institute for Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. Email: [email protected]
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Abstract

In 2006, the Dutch health insurance system was radically reformed to strengthen competition among health insurers as purchasers of health services. This article considers whether purchaser competition has improved efficiency in health-care provision. Although supply and price regulation still dominates the allocation of health services, purchaser competition has already significantly affected the provision of hospital care, pharmaceuticals and primary care, as well as efforts to gather and disseminate information about quality of care. From this perspective, the glass is half full. However, based on the crude performance indicators available, the reforms have not yet demonstrated significant effects on the performance of the Dutch health system. From this perspective the glass is half empty. The article concludes that the effectiveness of purchaser competition depends crucially on the success of ongoing efforts to improve performance indicators, product classification and the risk equalisation scheme.

Type
Debate
Information
Health Economics, Policy and Law , Volume 6 , Issue 1 , 26 January 2011 , pp. 109 - 123
Copyright
Copyright © Cambridge University Press 2011

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References

Baltesen, F. (2010), ‘Patiënt wenst operatie eerder, luxer en beter (Patient demands earlier, better and more luxurious operation)’, NRC Handelsblad, February 9: 3.Google Scholar
Berg, M., Meijerink, Y., Gras, M., Goossensen, A., Schellekens, W., Haeck, J., Kallewaart, M., Kingma, H. (2005), ‘Feasibility first: developing public performance indicators on patient safety and clinical effectiveness for Dutch hospitals’, Health Policy, 75: 59–73.Google Scholar
Boonen, L. H. H. M. (2009), ‘Consumer channeling in health care: (im)possible?’, PhD thesis, Erasmus University, Rotterdam.Google Scholar
Boonen, L. H. H. M., van der Geest, S. A., Schut, F. T.Varkevisser, M. (2010), ‘Pharmaceutical Policy in The Netherlands: from Price Regulation Towards Managed Competition’, in A. Dor (ed.), Pharmaceutical Markets and Insurance Worldwide, Advances in Health Economics and Health Services Research, vol. 22, Bingley: Emerald, 53–76.Google Scholar
Gaynor, M. (2006), ‘What do we know about competition and quality in health care markets?’, NBER Working Paper No. 12301, NBER, Cambridge, Mass.Google Scholar
Halbersma, R., Mikkers, M. C., Motchenkova, E.Seinen, I. (2007), Market Structure and Hospital-Insurer Bargaining in the Netherlands, Research Paper 2007/06. Utrecht: Dutch Healthcare Authority (NZa).Google Scholar
NZa (2008), Monitor Ziekenhuiszorg 2008 (Monitor Hospital Care 2008), Utrecht: Dutch Healthcare Authority (NZa).Google Scholar
NZa (2009a), Monitor Zorgverzekeringsmarkt 2009 (Monitor Health Insurance Market 2009), Utrecht: Dutch Healthcare Authority (NZa).Google Scholar
NZa (2009b), Monitor Ziekenhuiszorg 2009 (Monitor Hospital Care 2009), Utrecht: Dutch Healthcare Authority (NZa).Google Scholar
NZa (2009c), Functionele bekostiging vier niet-complexe chronische zorgvormen (Integrated Payment for Four Non-complex Chronic Diseases), Visiedocument. Utrecht: Dutch Healthcare Authority (NZa).Google Scholar
NZa (2009d), Monitor Huisartsenzorg 2008 (Monitor Family Care 2008), Utrecht: Dutch Healthcare Authority (NZa).Google Scholar
NZa (2009e), Marktimperfecties in de medisch specialistische zorg (Market Imperfections in Medical Specialist Care), Consultatiedocument. Utrecht: Dutch Healthcare Authority (NZa).Google Scholar
NZa (2010), Monitor Medisch specialistische zorg 2010 (Monitor Medical Specialist Care 2010), Utrecht: Dutch Healthcare Authority (NZa).Google Scholar
Paolucci, F., Schut, E., Beck, K., Greβ, S., van de Voorde, C.Zmora, I. (2007), ‘Supplementary health insurance as a tool for risk-selection in mandatory basic health insurance markets’, Health Economics, Policy and Law, 2(2): 173–192.Google Scholar
Pomp, M.Hasaart, F. (2009), ‘Aanbodgeïnduceerde vraag in de ziekenhuiszorg (Supplier-induced demand in hospital care)’, Economisch Statistische Berichten, 94(4562): 372–374.Google Scholar
Pons, H., Lingsma, H.Bal, R. (2009), ‘De ranglijst is een slechte raadgever (The ranking is a bad adviser)’, Medisch Contact, 64(47): 1669–1672.Google Scholar
Roos, A. F., Schut, F. T. (2009), ‘Spillover Effects of Supplementary on Basic Health Insurance: Evidence from the Netherlands’, iBMG Working Paper W2009.8, Erasmus University, Rotterdam.Google Scholar
Rosenau, P. V.Lako, C. J. (2008), ‘An experiment with regulated competition and individual mandates for universal health care: the new Dutch health insurance system’, Journal of Health Politics, Policy and Law, 33(6): 1031–1056.Google Scholar
RVZ (2009), Numerus fixus geneeskunde: loslaten of vasthouden (Numerus Fixus Medical Education: Release or Retain?), The Hague: Raad voor Volksgezondheid en Zorg (RVZ).Google Scholar
RVZ (2010), Relatie medisch specialist en ziekenhuis in het licht van de kwaliteit van zorg (Relationship between Medical Specialist and Hospital with Regard to Quality of Care), The Hague: Raad voor Volksgezondheid en Zorg (RVZ).Google Scholar
Schut, F. T.van de Ven, W. P. M. M. (2005), ‘Rationing and competition in the Dutch health care system’, Health Economics, 14: S59–S74.Google Scholar
Struijs, J. N., van Til, J. T.Baan, C. A. (2009), Experimenteren met keten-DBCs diabetes. De eerste zichtbare effecten (Experiments with Integrated Payments for Diabetes. The First Visible Effects), Bilthoven: RIVM.Google Scholar
Van de Ven, W. P. M. M.Schut, F. T. (2008), ‘Universal mandatory health insurance in the Netherlands: a model for the United States?’, Health Affairs, 27(3): 771–781.CrossRefGoogle Scholar
Van de Ven, W. P. M. M.Schut, F. T. (2009), ‘Managed competition in the Netherlands: still work-in-progress’, Health Economics, 18: 253–255.CrossRefGoogle ScholarPubMed
Van de Ven, W. P. M. M., Schut, F. T., Hermans, H. E. G. M., de Jong, J. D., van der Maat, M., Coppen, R., Groenewegen, P. P.Friele, R. D. (2009), Evaluatie Zorgverzekeringswet en Wet op de Zorgtoeslag (Evaluation of the Health Insurance Act and the Health Care Allowance Act), Programma evaluatie regelgeving: deel 27. The Hague: ZonMw, http://www.zonmw.nl/nl/publicaties/Google Scholar
Van Dishoeck, A., Looman, C., Wilden-van Lier, E., Mackenbach, J.Steyerberg, E. (2009), ‘Prestatieindicatoren voor ziekenhuizen (Performance indicators for hospitals)’, Nederlands Tijdschrijft voor Geneeskunde, 153: B161, 1–9.Google Scholar
Varkevisser, M. (2010), ‘Patient choice, competition and antitrust enforcement in Dutch hospital markets’, PhD thesis. Erasmus University, Rotterdam.Google Scholar
Vektis (2009a), Jaarcijfers 2009 – Zorgverzekeraars en – financiering (Annual figures 2009: Health insurers and financing), Zeist: Vektis.Google Scholar
Vektis (2009b), Zorgthermometer Vooruitblik 2010 (Care Thermometer Prospects for 2010), Zeist: Vektis.Google Scholar
Westert, G. P., van den Berg, M. J., Zwakhals, S. L. N., de Jong, J. D.Verkleij, H. (eds) (2010), Dutch Health Care Performance Report 2010, Bilthoven: RIVM.Google Scholar
ZN (2009), Reactie op visiedocument functionele bekostiging vier niet-complexe zorgvormen (Comments on Vision Document Integrated Payment for Four Non-complex Chronic Disease), Letter to NZa. Zeist: Zorgverzekeraars Nederland, http://www.nza.nl/binaries/7113/10057/91508/ZN.pdfGoogle Scholar