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Rationing and competition in the Dutch health-care system

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  • Frederik T. Schut

    (Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands)

  • Wynand P. M. M. Van de Ven

    (Department of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands)

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    Abstract

    In this paper we examine the goals and effects of health-care policy in the Netherlands over the period 1980-2000. During this period Dutch health-care policy is marked by a peculiar combination of increasingly stringent cost-containment policies alongside a persistent pursuit of market-oriented reforms. The main goal of cost containment was to keep labour costs down under the restriction of universal equal access to health care. Supply and price control policies were quite successful in achieving cost containment, but in due course prolonged quantity rationing began to jeopardise universal physical access to health services. The main goal of market-oriented health-care reforms is to increase the system's efficiency and its responsiveness to patient's needs, while maintaining equal access. The feasibility of the reforms crucially hinges on the realisation of adequate methods of risk adjustment, product classification and quality measurement, an appropriate consumer information system and an effective competition policy. Realising these preconditions requires a lengthy and cautious implementation process. Although considerable progress has been made in setting the appropriate stage for regulated competition in Dutch health care, the role of the market is still limited. Copyright © 2005 John Wiley & Sons, Ltd.

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    File URL: http://hdl.handle.net/10.1002/hec.1036
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    Bibliographic Info

    Article provided by John Wiley & Sons, Ltd. in its journal Health Economics.

    Volume (Year): 14 (2005)
    Issue (Month): S1 ()
    Pages: S59-S74

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    Handle: RePEc:wly:hlthec:v:14:y:2005:i:s1:p:s59-s74

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    Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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    References

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    1. Schut, Frederik T. & Hassink, Wolter H. J., 2002. "Managed competition and consumer price sensitivity in social health insurance," Journal of Health Economics, Elsevier, vol. 21(6), pages 1009-1029, November.
    2. Van de ven, Wynand P.M.M. & Ellis, Randall P., 2000. "Risk adjustment in competitive health plan markets," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 14, pages 755-845 Elsevier.
    3. van de Ven, Wynand P.M.M. & Schut, Frederik T., 1994. "Should catastrophic risks be included in a regulated competitive health insurance market?," Social Science & Medicine, Elsevier, vol. 39(10), pages 1459-1472, November.
    4. Zeynep Or, 2002. "Improving the Performance of Health Care Systems: From Measures to Action (A Review of Experiences in Four OECD Countries)," OECD Labour Market and Social Policy Occasional Papers 57, OECD Publishing.
    5. Paolucci, Francesco & Exter, Andre Den & De Ven, Wynand Van, 2006. "Solidarity in competitive health insurance markets: analysing the relevant EC legal framework," Health Economics, Policy and Law, Cambridge University Press, vol. 1(02), pages 107-126, April.
    6. Lamers, Leida M. & van Vliet, Rene C. J. A. & van de Ven, Wynand P. M. M., 2003. "Risk adjusted premium subsidies and risk sharing: key elements of the competitive sickness fund market in the Netherlands," Health Policy, Elsevier, vol. 65(1), pages 49-62, July.
    7. Lieverdink, Harm & Maarse, Hans, 1995. "Negotiating fees for medical specialists in the Netherlands," Health Policy, Elsevier, vol. 31(2), pages 81-101, February.
    8. W.B.F. Brouwer & F.T. Schut, 1999. "Priority care for employees: A blessing in disguise?," Health Economics, John Wiley & Sons, Ltd., vol. 8(1), pages 65-73.
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    Cited by:
    1. Ilaria Mosca & Anoushka Schut-Welkzijn, 2008. "Choice determinants of the mobility in the Dutch health insurance market," The European Journal of Health Economics, Springer, vol. 9(3), pages 261-264, August.
    2. Marco Varkevisser & Stéphanie Geest, 2007. "Why do patients bypass the nearest hospital? An empirical analysis for orthopaedic care and neurosurgery in the Netherlands," The European Journal of Health Economics, Springer, vol. 8(3), pages 287-295, September.
    3. Lieke H. H. M. Boonen & Frederik T. Schut & Xander Koolman, 2008. "Consumer channeling by health insurers: natural experiments with preferred providers in the Dutch pharmacy market," Health Economics, John Wiley & Sons, Ltd., vol. 17(3), pages 299-316.
    4. Toth, Federico, 2010. "Healthcare policies over the last 20 years: Reforms and counter-reforms," Health Policy, Elsevier, vol. 95(1), pages 82-89, April.
    5. Heinemann, Stephanie & Leiber, Simone & Greß, Stefan, 2013. "Managed competition in the Netherlands—A qualitative study," Health Policy, Elsevier, vol. 109(2), pages 113-121.
    6. Ron Kemp & Nikki Kersten & Astrid Severijnen, 2012. "Price Effects of Dutch Hospital Mergers: An Ex-post Assessment of Hip Surgery," De Economist, Springer, vol. 160(3), pages 237-255, September.
    7. Stefan Greß & Maral Manouguian & Jürgen Wasem, 2007. "Health Insurance Reform in the Netherlands," CESifo DICE Report, Ifo Institute for Economic Research at the University of Munich, vol. 5(1), pages 63-67, 05.
    8. Marco Varkevisser & Stéphanie Geest & Frederik Schut, 2010. "Assessing hospital competition when prices don’t matter to patients: the use of time-elasticities," International Journal of Health Care Finance and Economics, Springer, vol. 10(1), pages 43-60, March.
    9. Schut, Frederik T. & Varkevisser, Marco, 2013. "Tackling hospital waiting times: The impact of past and current policies in the Netherlands," Health Policy, Elsevier, vol. 113(1), pages 127-133.
    10. Johannes Schoder & Peter Zweifel, 2008. "The Contribution of Managed Care to the Performance of Healthcare Systems - Evidence from Three Countries," Swiss Journal of Economics and Statistics (SJES), Swiss Society of Economics and Statistics (SSES), vol. 144(III), pages 477-493, September.
    11. Greß, Stefan & Manouguian, Maral & Wasem, Jürgen, 2006. "Krankenversicherungsreform in den Niederlanden: Vorbild für einen Kompromiss zwischen Bürgerversicherung und Pauschalprämie in Deutschland?," IBES Diskussionsbeiträge 150, University of Duisburg-Essen, Faculty for Economics and Business Administration.
    12. Karen Eggleston & Randall P. Ellis & Mingshan Lu, 2007. "Prevention and Dynamic Risk Adjustment," Boston University - Department of Economics - Working Papers Series WP2007-023, Boston University - Department of Economics.
    13. Wynand P. M. M. Van de Ven & Frederik T. Schut, 2009. "Managed competition in the Netherlands: still work-in-progress," Health Economics, John Wiley & Sons, Ltd., vol. 18(3), pages 253-255.

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