[Managed competition in the health-care services - the Dutch experience]

For some years in Switzerland, in Germany and in the Netherlands some experience has been gathered with managed competition in health care. Efficiency reserves in the health service should be opened up by stronger competition orientation. Since the fundamental reform of the health insurance system in the Netherlands in 2006 the longest experience with the new governance model exists in this country. Health system experts in Germany and Switzerland maybe interested to include the experiences from the Netherlands into their further reforms. The analysis of relevant statistics and publications shows that, after 6 years, the results of the health reform in the Netherlands are to be called rather "sobering up". The competition activities of the health insurances, the insured persons and the providers are rather weak. However the expenditures for health are rising continuously. The intended goals of managed competition (reduction of costs and efficiency increase) could not be achieved in the Netherlands so far. The role of the health insurance companies and the competition readiness of the insured persons were obviously overrated, at the same time as well as the market power of the provider was rather underestimated.