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Choice of providers and mutual healthcare purchasers: can the English National Health Service learn from the Dutch reforms?1

Published online by Cambridge University Press:  01 July 2010

Gwyn Bevan  and
Wynand P. M. M. van de Ven
Gwyn Bevan*
Affiliation:
Professor of Management Science, Department of Management, London School of Economics and Political Science, London, UK
Wynand P. M. M. van de Ven
Affiliation:
Professor of Health Insurance, Department of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
*
Correspondence to: Gwyn Bevan, Professor of Management Science, Department of Management, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK. Email: [email protected]
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Abstract

In the 1990s, countries experimented with two models of health care reforms based on choice of provider and insurer. The governments of the UK, Italy, Sweden and New Zealand introduced relatively quickly ‘internal market’ models into their single-payer systems, to transform hierarchies into markets by separating ‘purchasers’ from ‘providers’, and enabling ‘purchasers’ to contract selectively with competing public and private providers so that ‘money followed the patient’. This model has largely been abandoned where it has been tried. England, however, has implemented a modified ‘internal market’ model emphasising patient choice, which has so far had disappointing results. In the Netherlands, it took nearly 20 years to implement successfully the model in which enrollees choose among multiple insurers; but these insurers have so far only realised in part their potential to contract selectively with competing providers. The paper discusses the difficulties of implementing these different models and what England and the Netherlands can learn from each other. This includes exploration, as a thought experiment, of how choice of purchaser might be introduced into the English National Health Service based on lessons from the Netherlands.

Type
Articles
Information
Health Economics, Policy and Law , Volume 5 , Issue 3: Special Issue on Cross-Country Issues in Health Care: Choice, Equity, Efficiency and Cost , July 2010 , pp. 343 - 363
Copyright
Copyright © Cambridge University Press 2010

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Footnotes

1

This paper was presented at the Autumn 2009 meeting of the European Health Policy Group.

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