Managed care and managed competition in the Netherlands (eingeladener Vortrag)

Background: Health insurers in the Netherlands are now privately owned and operated, but strongly regulated by the government, an economic concept known as „managed competition“. A central component of managed competition strategies is selective contracting between health insurers and healthcare providers. Objective: The goal of this research endeavour is to investigate key stakeholders' opinions about recent changes in Dutch healthcare policy regarding the extent to which policy changes have brought about the four central descriptors of healthcare (access, solidarity, financing and quality). Method: Expert interviews with 12 key stakeholders were performed (October/November 2009), transcribed and analyzed. Results: Access. Stakeholders believe that access remains good, but a growing group of citizens is not paying their monthly premiums. Instruments are being developed in order to retrieve these missing funds. Solidarity. Stakeholders are aware that the risk of a privatized system is that solidarity can be weakened if market controls fail. Stakeholders are therefore keeping a watchful eye on trends toward risk selection and counteracting them. The healthcare allowance is proving to be too costly, since nearly 70% of all Dutch households receive it. Politicians are considering options for containing these costs. Financing. In the first years following the reform, healthcare spending has continued to rise, albeit at a somewhat reduced rate. Health insurers are cutting internal costs. Most interviewees believe that the Health Insurance Act will have a positive effect on overall healthcare spending. Quality. The majority of stakeholders mentioned that transparency about healthcare quality in the Netherlands – including consumer information – is improving. Integrated care concepts for managing health-care efficiently and providing higher quality services are slow in developing. Patient organizations and insurers report taking part in such efforts, but other stakeholders do not perceive that progress has been made in this area.