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Some pain, no gain: experiences with the no-claim rebate in the Dutch health care system

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  • HOLLAND, J.
  • VAN EXEL, N.J.A.
  • SCHUT, F.T.
  • BROUWER, W.B.F.

Abstract

To contain expenditures in an increasingly demand driven health care system, in 2005 a no-claim rebate was introduced in the Dutch health insurance system. Since demand-side cost sharing is a very controversial issue, the no-claim rebate was launched as a consumer friendly bonus system to reward prudent utilization of health services. Internationally, the introduction of a mandatory no-claim rebate in a social health insurance scheme is unprecedented. Consumers were entitled to an annual rebate of ₠ 255 if no claims were made. During the year, all health care expenses except for GP visits and maternity care were deducted from the rebate until the rebate became zero. In this article, we discuss the rationale of the no-claim rebate and the available evidence of its effect. Using a questionnaire in a convenience sample, we examined people’s knowledge, attitudes, and sensitivity to the incentive scheme. We find that only 4% of respondents stated that they would reduce consumption because of the no-claim rebate. Respondents also indicated that they were willing to accept a high loss of rebate in order to use a medical treatment. However, during the last month of the year many respondents seemed willing to postpone consumption until the next year in order to keep the rebate of the current year intact. A small majority of respondents considered the no-claim rebate to be unfair. Finally, we briefly discuss why in 2008 the no-claim rebate was replaced by a mandatory deductible.

Suggested Citation

  • Holland, J. & Van Exel, N.J.A. & Schut, F.T. & Brouwer, W.B.F., 2009. "Some pain, no gain: experiences with the no-claim rebate in the Dutch health care system," Health Economics, Policy and Law, Cambridge University Press, vol. 4(4), pages 405-424, October.
  • Handle: RePEc:cup:hecopl:v:4:y:2009:i:04:p:405-424_00
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    Cited by:

    1. Remmerswaal, Minke & Boone, Jan & Bijlsma, Michiel & Douven, R.C.M.H., 2017. "Cost-Sharing Design Matters : A Comparison of the Rebate and Deductible in Healthcare," Other publications TiSEM 624251d4-89fb-4c0b-8dd1-f, Tilburg University, School of Economics and Management.
    2. K. P. M. Winssen & R. C. Kleef & W. P. M. M. Ven, 2016. "Potential determinants of deductible uptake in health insurance: How to increase uptake in The Netherlands?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(9), pages 1059-1072, December.
    3. Minke Remmerswaal & Jan Boone & Michiel Bijlsma & Rudy Douven, 2017. "Cost-Sharing Design Matters: A Comparison of the Rebate and Deductible in Healthcare," CPB Discussion Paper 367, CPB Netherlands Bureau for Economic Policy Analysis.
    4. Remmerswaal, Minke & Boone, Jan & Bijlsma, Michiel & Douven, R.C.M.H., 2017. "Cost-Sharing Design Matters : A Comparison of the Rebate and Deductible in Healthcare," Discussion Paper 2017-039, Tilburg University, Tilburg Law and Economic Center.
    5. Remmerswaal, Minke & Boone, Jan & Bijlsma, Michiel & Douven, Rudy, 2019. "Cost-sharing design matters: A comparison of the rebate and deductible in healthcare," Journal of Public Economics, Elsevier, vol. 170(C), pages 83-97.
    6. Boone, Jan & Remmerswaal, Minke & Bijlsma, Michiel & Douven, Rudy, 2017. "Cost-Sharing Design Matters: A Comparison of the Rebate and Deductible in Healthcare," CEPR Discussion Papers 12507, C.E.P.R. Discussion Papers.
    7. Remmerswaal, Minke & Boone, Jan & Bijlsma, Michiel & Douven, R.C.M.H., 2017. "Cost-Sharing Design Matters : A Comparison of the Rebate and Deductible in Healthcare," Other publications TiSEM 67163c04-3d3b-499c-882c-d, Tilburg University, School of Economics and Management.

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