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Managed competition in the Netherlands-a qualitative study.

Stephanie Heinemann¹, Simone Leiber, Stefan Gress

¹Department of Health Sciences, University of Applied Sciences Fulda, Germany. stephanie.heinemann@pg.hs-fulda.de

Health Policy (Amsterdam, Netherlands)

|October 4, 2012

Summary

Dutch healthcare policy changes in 2006 aimed for managed competition, but key elements like risk adjustment and consumer choice are still developing. Stakeholders report slow progress in implementing managed care instruments.

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Area of Science:

Health Policy Analysis
Healthcare Management
Health Economics

Background:

Dutch health insurance underwent significant reform in 2006 with the Health Insurance Act, introducing government-regulated managed competition.
The policy aimed to foster a competitive health insurance market while maintaining government oversight.

Purpose of the Study:

To evaluate key stakeholders' perceptions of recent Dutch healthcare policy changes.
To assess the effectiveness of risk-adjustment, consumer choice, and managed care instruments within the Dutch system.

Main Methods:

Qualitative analysis of expert interviews with 12 key stakeholders.
Interviews were conducted in October/November 2009 and analyzed through a four-step process.

Main Results:

The Dutch risk-adjustment scheme is advanced, yet incentives for insurers to select low-risk individuals persist.
Consumer choice has shifted towards collective decision-making through large group contracts, rather than individual preferences.
Development of managed care concepts is slow, with mixed perceptions of progress among stakeholders.

Conclusions:

The foundational elements for successful managed competition in the Netherlands are not fully established.
Risk-adjustment mechanisms require further refinement to mitigate all selection incentives.
Consumer preferences are beginning to influence insurer strategies, and managed care is in its nascent stages of development.