Managed competition in The Netherlands: lessons from five years of health care reform

In many European countries health care reforms are taking place. The guiding principle of the reforms is 'more market, less government'. In 1988 the Dutch Government launched proposals for the most radical market-oriented reform in Western Europe. The proposed system can be described as a national health insurance based on regulated competition among both insurers and providers of health care. It can be seen as an ingenious attempt to combine the 'efficiency' of competitive arrangements in the markets for health care and health insurance with the 'equity' of finance through predominantly income-related premiums (National Economic Research Associates 1993). Similar reforms have been proposed and discussed in other countries. In this paper we will concentrate on lessons that other countries may learn from the Dutch experience. What progress has been made since the proclamation of the reforms six years ago? What new issues and problems have arisen and how can we solve these new problems?