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Choice of providers and mutual healthcare purchasers: can the English National Health Service learn from the Dutch reforms?


  • Bevan, Gwyn
  • van de Ven, Wynand P. M. M.


In the 1990s, countries experimented with two models of health care reforms based on choice of provider and insurer. The governments of the UK, Italy, Sweden and New Zealand introduced relatively quickly ‘internal market’ models into their single-payer systems, to transform hierarchies into markets by separating ‘purchasers’ from ‘providers’, and enabling ‘purchasers’ to contract selectively with competing public and private providers so that ‘money followed the patient’. This model has largely been abandoned where it has been tried. England, however, has implemented a modified ‘internal market’ model emphasising patient choice, which has so far had disappointing results. In the Netherlands, it took nearly 20 years to implement successfully the model in which enrollees choose among multiple insurers; but these insurers have so far only realised in part their potential to contract selectively with competing providers. The paper discusses the difficulties of implementing these different models and what England and the Netherlands can learn from each other. This includes exploration, as a thought experiment, of how choice of purchaser might be introduced into the English National Health Service based on lessons from the Netherlands.

Suggested Citation

  • Bevan, Gwyn & van de Ven, Wynand P. M. M., 2010. "Choice of providers and mutual healthcare purchasers: can the English National Health Service learn from the Dutch reforms?," Health Economics, Policy and Law, Cambridge University Press, vol. 5(03), pages 343-363, July.
  • Handle: RePEc:cup:hecopl:v:5:y:2010:i:03:p:343-363_00

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    Cited by:

    1. Mark Stabile & Sarah Thomson, 2014. "The Changing Role of Government in Financing Health Care: An International Perspective," Journal of Economic Literature, American Economic Association, vol. 52(2), pages 480-518, June.
    2. Sergey Shishkin & Alexandra Burdyak & Elena Potapchik, 2013. "Patient choice in the post-Semashko health care system," HSE Working papers WP BRP 09/PA/2013, National Research University Higher School of Economics.
    3. Sowa, P. Marcin & Butler, James R.G. & Connelly, Luke B., 2014. "Unmet medical needs and health care accessibility in seven countries of Eastern Europe," MPRA Paper 75619, University Library of Munich, Germany.
    4. Xu, Weiwei & van de Ven, Wynand P.M.M., 2013. "Consumer choice among Mutual Healthcare Purchasers: A feasible option for China?," Social Science & Medicine, Elsevier, vol. 96(C), pages 277-284.
    5. repec:eso:journl:v:48:y:2017:i:1:p:61-84 is not listed on IDEAS
    6. Thomson, Sarah & Busse, Reinhard & Crivelli, Luca & van de Ven, Wynand & Van de Voorde, Carine, 2013. "Statutory health insurance competition in Europe: A four-country comparison," Health Policy, Elsevier, vol. 109(3), pages 209-225.
    7. Heijink, Richard & Mosca, Ilaria & Westert, Gert, 2013. "Effects of regulated competition on key outcomes of care: Cataract surgeries in the Netherlands," Health Policy, Elsevier, vol. 113(1), pages 142-150.

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