Van de Ven W & Schut F, (2000)

‘The First Decade of Market Oriented Health Care Reforms in the Netherlands’

Draft available here

• 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.

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