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Preferred providers and the credible commitment problem in health insurance: first experiences with the implementation of managed competition in the Dutch health care system

Published online by Cambridge University Press:  02 December 2010

Lieke H. H. M. Boonen  and
Frederik T. Schut
Lieke H. H. M. Boonen*
Affiliation:
Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
Frederik T. Schut
Affiliation:
Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
*
*Correspondence to: Lieke Boonen, Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. Email: [email protected]
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Abstract

We investigate the impact of the transition towards managed competition in the Dutch health care system on health insurers’ contracting behaviour. Specifically, we examine whether insurers have been able to take up their role as prudent buyers of care and examine consumers’ attitudes towards insurers’ new role. Health insurers’ contracting behaviour is investigated by an extensive analysis of available information on purchasing practices by health insurers and by interviews with directors of health care purchasing of the four major health insurers, accounting for 90% of the market. Consumer attitudes towards insurers’ new role are investigated by surveys among a representative sample of enrollees over the period 2005–2009. During the first four years of the reform, health insurers were very reluctant to engage in selective contracting and preferred to use ‘soft’ positive incentives to encourage preferred provider choice rather than engaging in restrictive managed care activities. Consumer attitudes towards channelling vary considerably by type of provider but generally became more negative in the first two years after the reform. Insurers’ reluctance to use selective contracting can be at least partly explained by the presence of a credible-commitment problem. Consumers do not trust that insurers with restrictive networks are committed to provide good quality care. The credible-commitment problem seems to be particularly relevant to the Netherlands, since Dutch enrollees are not used to restrictions on provider choice. Since consumers are quite sensitive to differences in provider quality, more reliable information about provider quality is required to reduce the credible-commitment problem.

Type
Articles
Information
Health Economics, Policy and Law , Volume 6 , Issue 2 , 16 March 2011 , pp. 219 - 235
Copyright
Copyright © Cambridge University Press 2010

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References

Capps, C., Dranove, D., Greenstein, S., Satterthwaite, M. (2001), ‘The silent majority fallacy of the Elzinga-Hogarty criteria: a critique and new approach to analyzing hospital mergers’, NBER Working Paper no. 8216, Cambridge, MA.CrossRefGoogle Scholar
Capps, C., Dranove, D.Satterthwaite, M. (2003), ‘Competition and market power in option demand markets’, RAND Journal of Economics, 34(4): 737–763.CrossRefGoogle ScholarPubMed
Claxton, G., Gabel, J. R., Dijulio, B., Pickreign, J., Whitmore, H., Finder, B., Jarlenski, M.Hawkins, S. (2008), ‘Health benefits in 2008: premiums moderately higher, while enrollment in consumer-directed plans rises in small firms’, Health Affairs, 27(6): 492–502.CrossRefGoogle ScholarPubMed
CZ (2009), ‘Belonen zorgkeuze patiënt moet weloverwogen gebeuren’ (Rewarding patients for provider choice has to be done carefully), Press statement, CZ-DLO, Tilburg, April 23.Google Scholar
DFZ (2009), ‘De Friesland stopt met experiment eigen risico’ (De Friesland stops experiment with deductible), Press statement, De Friesland Zorgverzekeraar, Leeuwarden, September 24.Google Scholar
Dranove, D., Lindrooth, R., White, W. D.Zwanziger, J. (2008), ‘Is the impact of managed care on hospital prices decreasing?’, Journal of Health Economics, 27(2): 362–376.CrossRefGoogle ScholarPubMed
Enthoven, A. C.van de Ven, W. P. M. M. (2007), ‘Going Dutch – Managed-Competition Health Insurance in the Netherlands’, The New England Journal of Medicine, 357(24): 2421–2423.CrossRefGoogle ScholarPubMed
Glied, S. (2000), ‘Managed care’, in A. J. and J. P. Newhouse (eds), Handbook of Health Economics, Volume 1. Amsterdam: Elsevier, 707–753.Google Scholar
Heida, J. P., Stam, P. A. J., Boonen, L. H. H. M. (2009), ‘Inkoopbeleid moet duidelijk zijn (Purchasing policy must be clear)’. Het Financieele Dagblad, December 1.Google Scholar
Ho, K. (2009), ‘Barriers to entry of a vertically integrated health insurer: an analysis of welfare and entry costs’, Journal of Economics and Management Strategy, 18(2): 487–545.Google Scholar
Keuzenkamp, H. (2006), ‘Willen we wel kiezen?’ (Do we really want to choose?), Presentation prepared for the VGE conference ‘Kiezen in de Zorg’, Erasmus University Rotterdam, The Netherlands.Google Scholar
Melnick, G. A., Zwanziger, J., Bamezai, A.Pattison, R. (1992), ‘The effects of market structure and bargaining position on hospital prices’, Journal of Health Economics, 11(3): 217–233.CrossRefGoogle ScholarPubMed
Miller, N. H. (2006), ‘Insurer–provider integration, credible commitment, and managed-care backlash’, Journal of Health Economics, 25(5): 861–876.CrossRefGoogle ScholarPubMed
Nza (2007), Richting Geven aan Keuzes. Kunnen Verzekeraars Consumenten Stimuleren naar Gecontracteerde Voorkeursaanbieders te Gaan? (Directing Choices. Are Insurers Able to Motivate Consumers to Use Contracted Preferred Providers?), Utrecht: Dutch Healthcare Authority.Google Scholar
NZa (2008a), Monitor Zorgverzekeringsmarkt 2008 (Monitor Health Insurance Market 2008), Utrecht: Dutch Healthcare Authority.Google Scholar
NZa (2008b), Monitor Eigen risico (Monitor Deductible), Utrecht: Dutch Healthcare Authority.Google Scholar
NZa (2009), Monitor Zorgverzekeringsmarkt 2009 (Monitor Health Insurance Market 2009), Utrecht: Dutch Healthcare Authority.Google Scholar
Pauly, M. V. (1987), ‘Monopsony power in health insurance: thinking straight while standing on your head’, Journal of Health Economics, 6(1): 73–81.CrossRefGoogle ScholarPubMed
Smith, D. G. (1997), ‘The effects of preferred provider organisations on health care use and costs’, Inquiry, 34(4): 278–287.Google ScholarPubMed
Sorensen, A. T. (2003), ‘Insurer–hospital bargaining: negotiated discounts in post-deregulation connecticut’, Journal of Industrial Economics, 51(4): 469–490.CrossRefGoogle Scholar
Staten, M., Dunkelberg, W.Umbeck, J. (1987), ‘Market share and the illusion of power. Can Blue Cross force hospitals to discount?’, Journal of Health Economics, 6(1): 43–58.CrossRefGoogle ScholarPubMed
Town, R.Vistnes, G. (2001), ‘Hospital competition in HMO networks’, Journal of Health Economics, 20(5): 733–753.CrossRefGoogle ScholarPubMed
Tversky, A.Kahneman, D. (1991), ‘Loss aversion in riskless choice: a reference-dependent model’, Quarterly Journal of Economics, 106(4): 1039–1061.CrossRefGoogle Scholar
Van de Ven, W. P.Schut, F. T. (2009), ‘Managed competition in the Netherlands: still work-in-progress’, Health Economics, 18(3): 253–255.CrossRefGoogle ScholarPubMed
Van den Berg, B., Van Dommelen, P., Stam, P., Laske-Aldershof, T., Buchmueller, T.Schut, F. T. (2008), ‘Preferences and choices for care and health insurance’, Social Science and Medicine, 66(12): 2448–2459.CrossRefGoogle ScholarPubMed
Wu, V. Y. (2009), ‘Managed care’s price bargaining with hospitals’, Journal of Health Economics, 28(2): 350–360.CrossRefGoogle ScholarPubMed
Zwanziger, J.Mooney, C. (2005), ‘Has price competition changed hospital revenues and expenses in New York?’, Inquiry, 42(2): 183–192.CrossRefGoogle ScholarPubMed