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Health Care Reform and Long-Term Care in the Netherlands

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  • Erik Schut
  • Stéphane Sorbe
  • Jens Høj

Abstract

The Netherlands, as other OECD countries, faces the challenge of providing high quality health and long-term care services to an ageing population in a cost-efficient manner. In the health care sector, reforms have aimed at introducing more competition. Despite major changes and some positive effects, the reforms run the risk of getting stuck in the middle between a centralised system of state-controlled supply and prices and a decentralised system based on regulated competition, providing insufficient incentives for provision of quality services and expenditure control. The main challenges are to complete the transition to regulated competition in health care provision, to strengthen the role of health insurers as purchasing agents and to secure cost containment in an increasingly demand-driven health care sector. In 2012, reforms expanded the role of the market in the hospital sector and reinforced budget controls. Both measures are not consistent and may jeopardize both objectives. More competitive markets require, at least, provision of good quality information, appropriate financing and better efficiency incentives. In view of population ageing, current policies mean that the cost of long-term care is set to more than double over the coming decades. Insufficient incentives for cost-efficient purchasing of long-term care should be addressed. However, the government?s plan to transfer long-term care purchasing to health insurers is unpromising unless additional measures ensure that insurers bear the associated financial risks. In addition, home care should be further encouraged at the expense of institutional care, while screening and targeting should be improved. This Working Paper relates to the 2012 OECD Economic Survey of the Netherlands (www.oecd.org/eco/surveys/Netherlands. Réforme des soins de santé et soins de longue durée aux Pays-Bas Les Pays-Bas, comme les autres pays de l?OCDE, sont confrontés à la difficulté de fournir, au meilleur coût, des services de santé et des soins de longue durée de haute qualité à une population vieillissante. Dans le secteur de la santé, des réformes ont déjà été mises en oeuvre en vue d?intensifier la concurrence. Malgré des changements majeurs et certains effets positifs, les réformes risquent de s?enliser, prises en étau entre un système centralisé d?offre et de prix contrôlés par l?État et un système décentralisé fondé sur une concurrence réglementée, n?incitant pas suffisamment à fournir des services de qualité et à maîtriser les dépenses. Les principales difficultés consistent à mener à bien la transition vers un régime de concurrence réglementée dans la prestation de soins de santé, à renforcer le rôle des assureurs en tant qu'agents acheteurs et à assurer la maîtrise des coûts dans un secteur de la santé qui obéit de plus en plus à la demande. En 2012, les réformes ont accru le rôle du marché dans le secteur hospitalier et renforcé les contrôles budgétaires. Ces deux mesures ne sont pas compatibles et risquent de compromettre la réalisation des deux objectifs. Des marchés plus concurrentiels requièrent, au minimum, une information de bonne qualité, un financement approprié et des incitations plus fortes à l?efficience. Compte tenu du vieillissement de la population, les politiques actuelles feront plus que doubler le coût des soins de longue durée au cours des décennies à venir. Il faudrait inciter davantage à l?achat de soins de longue durée efficaces par rapport à leur coût. Cependant, le plan du gouvernement consistant à transférer l?achat de soins de longue durée aux assureurs est voué à l?échec en l?absence de mesures supplémentaires faisant supporter à ces derniers les risques financiers correspondants. Il faudrait en outre encourager les soins à domicile aux dépens des soins en établissement, tout en améliorant le filtrage et la fixation d?objectifs. Ce document de travail se rapporte à l?Étude économique des Pays-Bas de 2012 (www.oecd.org/eco/etudes/Pays-Bas).

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Bibliographic Info

Paper provided by OECD Publishing in its series OECD Economics Department Working Papers with number 1010.

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Date of creation: 11 Jan 2013
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Handle: RePEc:oec:ecoaaa:1010-en

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Keywords: Netherlands; long-term care; health care reforms; regulated competition; health insurance; hospitals; hôpitaux; concurrence réglementée; Pays-Bas; assurance santé; réforme des systèmes de santé; soins de longue durée;

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Cited by:
  1. Jan Boone & Rudy Douven, 2014. "Provider competition and over-utilization in health care," CPB Discussion Paper 275, CPB Netherlands Bureau for Economic Policy Analysis.

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