Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-23T20:05:51.514Z Has data issue: false hasContentIssue false
  • English
  • Français

Health plan choice in the Netherlands: restrictive health plans preferred by young and healthy individuals

Published online by Cambridge University Press:  14 March 2017

Romy E. Bes ,
Emile C. Curfs ,
Peter P. Groenewegen  and
Judith D. de Jong
Romy E. Bes*
Affiliation:
Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513 CR, Utrecht, The Netherlands Open University, Valkenburgerweg 177, 6419 AT, Heerlen, The Netherlands
Emile C. Curfs
Affiliation:
Open University, Valkenburgerweg 177, 6419 AT, Heerlen, The Netherlands
Peter P. Groenewegen
Affiliation:
Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513 CR, Utrecht, The Netherlands
Judith D. de Jong
Affiliation:
Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, 3513 CR, Utrecht, The Netherlands
*
*Correspondence to: Romy E. Bes, NIVEL, Otterstraat 118-124, 3513 CR, Utrecht, The Netherlands. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

In a health care system based on managed competition, health insurers negotiate on quality and price with care providers and are allowed to offer restrictive health plans. It is crucial that enrolees who need care choose restrictive health plans, as otherwise health insurers cannot channel patients to contracted providers and they will lose their bargaining power in negotiations with providers. We aim to explain enrolees’ choice of a restrictive health plan in exchange for a lower premium. In 2014 an online survey with an experimental design was conducted on members of an access panel (response 78%; n=3,417). Results showed 37.4% of respondents willing to choose a restrictive health plan in exchange for a lower premium. This fell to 22% when the restrictive health plan also included a longer travelling time. Enrolees who choose a restrictive health plan are younger and healthier, or on lower incomes, than those preferring a non-restrictive one. This means that enrolees who use care will be unlikely to choose a restrictive health plan and, therefore, health insurers will not be able to channel them to contracted care providers. This undermines the goals of the health care system based on managed competition.

Type
Articles
Information
Health Economics, Policy and Law , Volume 12 , Issue 3 , July 2017 , pp. 345 - 362
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bes, R. E., Wendel, S. and de Jong, J. D. (2012), ‘Het vertrouwensprobleem van zorgverzekeraars [The trust issue of health insurers]’, Economisch Statistische Berichten, 97(4647): 676–677.Google Scholar
Bes, R. E., Wendel, S., Curfs, E. C., Groenewegen, P. P. and de Jong, J. D. (2013), ‘Acceptance of selective contracting: the role of trust in the health insurer’, BMC Health Services Research, 13: 375. https://doi.org/doi:10.1186/1472-6963-13-375.Google Scholar
Bes, R. E., Brabers, A. E. M., Reitsma-van Rooijen, M. and de Jong, J. D. (2014), Selectief contracteren? Prima, maar beperk mijn keuzevrijheid niet! [Selective Contracting? Fine, but Do Not Restrict My Freedom of Choice!], Utrecht, the Netherlands: NIVEL.Google Scholar
Bes, R. E., Curfs, E. C., Groenewegen, P. P. and de Jong, J. D. (2015), ‘Selective contracting and channelling patients to preferred providers: a scoping review’, Health Policy (under review).CrossRefGoogle Scholar
Boonen, L. H. and Schut, F. T. (2011), ‘Preferred providers and the credible commitment problem in health insurance: first experiences with the implementation of managed competition in the Dutch health care system’, Health Economics, Policy and Law, 6: 219–235.CrossRefGoogle ScholarPubMed
Boonen, L. H., Schut, F. T. and Koolman, X. (2008), ‘Consumer channeling by health insurers: natural experiments with preferred providers in the Dutch pharmacy market’, Health Economics, 17: 299–316.CrossRefGoogle ScholarPubMed
Boonen, L. H., Schut, F. T., Donkers, B. and Koolman, X. (2009), ‘Which preferred providers are really preferred? Effectiveness of insurers’ channeling incentives on pharmacy choice’, International Journal of Health Care Finance Economics, 9: 347–366.CrossRefGoogle ScholarPubMed
Brabers, A. E. M., Reitsma-van Rooijen, M. and de Jong, J. D. (2012), ‘The Dutch health insurance system: mostly competition on price rather than quality of care’, Eurohealth Systems and Policies, 28(1): 30–32.Google Scholar
Chernew, M., Scanlon, D. P. and Hayward, R. (1998), ‘Insurance type and choice of hospital for coronary artery bypass graft surgery’, Health Services Research, 33(3): 447–466.Google ScholarPubMed
Chu-Weininger, M. Y. L. and Balkrishnan, R. (2006), ‘Consumer satisfaction with primary care provider choice and associated trust’, BMC Health Services Research, 6: 139.Google Scholar
Cunningham, P. J., Denk, C. and Sinclair, M. (2001), ‘Do consumers know how their health plan works?’, Health Affairs, 20(3): 159–166.CrossRefGoogle ScholarPubMed
Davis, K., Collins, K. S., Schoen, C. and Morris, C. (1995), ‘Choice matters: enrollees’ views of their health plans’, Health Affairs, 14(2): 99–112.CrossRefGoogle ScholarPubMed
De Jong, J. D., Groenewegen, P. P. and Van der Schee, E. (2006), ‘Consumenten en de stelselwijziging [Consumers and the health care reform]’, Tijdschrift voor Gezondheidswetenschappen, 84(5): 288–2091.Google Scholar
Determan, D., Lambooij, M. S., de Bekker-Grob, E. W., Hayen, A. P., Varkevisser, M., Schut, F. T. and de Wit, G. A. (2016), ‘What health plans do people prefer? The trade off between premium and provider choice’, Social Science & Medicine, 165: 10–18.Google Scholar
Dutch Health Care Authority (2007), Richting geven aan keuzes. Kunnen verzekeraars consumenten stimuleren naar gecontracteerde voorkeursaanbieders te gaan? [Directions to Choices. Can Health Insurers Stimulate Consumers to Visit Contracted Preferred Providers?], Utrecht, the Netherlands: Dutch Health Care Authority.Google Scholar
Dutch Health Care Authority (2015), Zeventien zorgpolissen nader bekeken. In relatie tot de zorgplicht [A Closer Look at Seventeen Health Plans. In Relation to the Duty to Care], Utrecht, the Netherlands: Dutch Health Care Authority.Google Scholar
Enthoven, A. C. (1993), ‘The history and principles of managed competition’, Health Affairs, 12(1): 24–48.Google Scholar
Enthoven, A. C. (2008), ‘A living model of managed competition: a conversation with Dutch health minister Ab Klink’, Health Affairs, 27(3): 196–203.Google Scholar
Hellinger, F. J. (1995), ‘Selection bias in HMOs and PPOs: a review of the evidence’, Inquiry, 32(4): 135–142.Google ScholarPubMed
Hellinger, F. J. and Wong, H. S. (2000), ‘Selection bias in HMOs: a review of the evidence’, Medical Care Research and Review, 57(4): 405–439.CrossRefGoogle ScholarPubMed
Hoch, S. J., Kim, B. D., Montgomery, A. L. and Rossi, P. E. (1995), ‘Determinants of store-level price elasticity’, Journal of Marketing Research, 32: 17–29.CrossRefGoogle Scholar
Jianakoplos, N. A. and Bernasek, A. (1998), ‘Are women more risk averse?’, Economic Enquiry, 36(4): 620–630.Google Scholar
Kemper, P., Tu, H. T., Reschovsky, J. D. and Schaefer, E. (2002), ‘Insurance product design and its effects: trade-offs along the managed care continuum’, Inquiry, 39: 101–117.CrossRefGoogle ScholarPubMed
Kortenhoeven, D. (1990), Vrouwelijke artsen en vestiging als huisarts [Female Physicians Establishing a General Practice], Utrecht, the Netherlands: Bohn, Scheltema & Holkema.Google Scholar
Laske-Aldershof, T., Schut, E., Beck, K., Gress, S., Shmueli, A. and Van de Voorde, C. (2004), ‘Consumer mobility in social health insurance markets: a five country comparison’, Applied Health Economics and Health Policy, 3: 229–241.Google Scholar
Lave, C. A. and March, J. G. (1975), An Introduction to Models in the Social Sciences, New York: HarperCollins Publishers.Google Scholar
Lehman, H. and Zweifel, P. (2004), ‘Innovation and risk selection in deregulated social health insurance’, Journal of Health Economics, 23: 997–1012.CrossRefGoogle Scholar
Marquis, S. M. and Long, S. H. (1995), ‘Worker demand for health insurance in the non-group market’, Journal of Health Economics, 14: 47–63.Google Scholar
Mello, M. M., Stearns, S. C., Norton, E. C. and Ricketts, T. C. (2003), ‘Understanding biased selection in medicare HMOs’, Health Services Research, 38(3): 961–992.CrossRefGoogle ScholarPubMed
Rijken, M., de Putter, I., Reitsma-van Rooijen, M., Spreeuwenberg, P., de Jong, J. D. and Groenewegen, P. P. (2015), ‘Illness-related expenditures of people with chronic illness and of the general Dutch population: mind the gap!’, Health Policy (under review).Google Scholar
Scanlon, D. P., Chernew, M. and Lave, J. R. (1997), ‘Consumer health plan choice: current knowledge and future directions’, Annual Review of Public Health, 18: 507–528.CrossRefGoogle ScholarPubMed
Schmittdiel, J., Selby, J. V., Grumbach, K. and Quesenberry, C. P. (1997), ‘Choice of a personal physician and patient satisfaction in a health maintenance organization’, Journal of the American Medical Association, 278(19): 1596–1599.CrossRefGoogle Scholar
Sorensen, A. T. (2003), ‘Insurer-hospital bargaining: negotiated discounts in post-deregulation Conneticut’, Journal of Industrial Economics, 51(4): 469–490.Google Scholar
Tai, W. T. C., Porell, F. W. and Adams, E. K. (2004), ‘Hospital choice of rural medicare beneficiaries: patient, hospital attributes and patient-physician relationship’, Health Services Research, 39(6, Pt 1): 1903–1922.CrossRefGoogle ScholarPubMed
Tai-Seale, M. and Pescosolido, B. (2003), ‘The public’s opinions of physicians: Do perceived choice and exercised choice matter?’, The American Journal of Managed Care, 9(9): 631–638.Google Scholar
Taylor, J. W. (1974), ‘The role of risk in consumer behavior’, Journal of Marketing, 38: 54–60.Google Scholar
Tu, H. T. (2005), ‘More Americans willing to limit physician-hospital choice for lower medical costs’, Center for Studying Health System Change, 94: 1–5.Google Scholar
Van de Ven, W. P., Beck, K., Buchner, F., Schokkaert, E., Schut, F. T., Shmueli, A. and Wasem, J. (2013), ‘Preconditions for efficiency and affordability in competitive healthcare markets: are they fulfilled in Belgium, Germany, Israel, the Netherlands and Switzerland?’, Health Policy, 109: 226–245.CrossRefGoogle ScholarPubMed
Varkevisser, M. and Van der Geest, S. A. (2007), ‘Why do patients bypass the nearest hospital? An empirical analysis for orthopaedics care and neurosurgery in the Netherlands’, European Journal of Health Economics, 8(3): 287–295.CrossRefGoogle ScholarPubMed
Varkevisser, M., Van der Geest, S. A. and Schut, F. T. (2009), ‘Assessing hospital competition when prices don’t matter to patients: the use of time-elasticities’, International Journal of Health Care Finance Economy, 10(1): 43–60.CrossRefGoogle Scholar
Wu, V. Y. (2009), ‘Managed care´s price bargaining with hospitals’, Journal of Health Economics, 28: 350–360.Google Scholar