‘The First Decade of Market Oriented Health Care Reforms in the Netherlands’
Discussion of the Dutch healthcare system and its uneven history of ambitious reform proposals but patchy policy implementation.
The Dutch healthcare system involves more private enterprise than many other European countries, but also a great deal of government regulation.
Less than 10% of total health care spending is financed out of general taxation. Instead there is a system of compulsory national health insurance against ‘catastrophic risks’ (e.g. hospital care exceeding 1 year).
For ‘non-catastrophic’ risks individuals with earnings below a legally determined level (62% of the population) join mandatory ‘sickness funds’ (choosing from about 30 providers), while the remainder can voluntarily buy individual or group private insurance (from around 50 companies).
Creating competition between sickness funds has made them more responsive, and created price competition. However political resistance and provider collusion has hampered the implementation of many reforms.
The authors conclude with a discussion of the difficult trade-off between creating incentives for efficiency vs. creating incentives for cream-skimming. In the absence of perfect risk-adjustment, shifting risk to sickness funds creates incentives for both efficiency and cream-skimming.
