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Rationing and competition in the Dutch health-care system


  • 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)


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.

Suggested Citation

  • Frederik T. Schut & Wynand P. M. M. Van de Ven, 2005. "Rationing and competition in the Dutch health-care system," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 59-74.
  • Handle: RePEc:wly:hlthec:v:14:y:2005:i:s1:p:s59-s74 DOI: 10.1002/hec.1036

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    References listed on IDEAS

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    1. Puck Beukers & Ron Kemp & Marco Varkevisser, 2014. "Patient hospital choice for hip replacement: empirical evidence from the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(9), pages 927-936, December.
    2. 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.
    3. 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.
    4. 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, Institute of Business and Economic Studie (IBES).
    5. 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.
    6. Toth, Federico, 2010. "Healthcare policies over the last 20 years: Reforms and counter-reforms," Health Policy, Elsevier, vol. 95(1), pages 82-89, April.
    7. Tsiachristas, Apostolos & Hipple-Walters, Bethany & Lemmens, Karin M.M. & Nieboer, Anna P. & Rutten-van Mölken, Maureen P.M.H., 2011. "Towards integrated care for chronic conditions: Dutch policy developments to overcome the (financial) barriers," Health Policy, Elsevier, vol. 101(2), pages 122-132, July.
    8. repec:ces:ifodic:v:5:y:2007:i:1:p:14567270 is not listed on IDEAS
    9. 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.
    10. 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 Economics and Management, Springer, vol. 10(1), pages 43-60, March.
    11. repec:taf:pubmmg:v:36:y:2016:i:6:p:409-416 is not listed on IDEAS
    12. Ilaria Mosca & Anoushka Schut-Welkzijn, 2008. "Choice determinants of the mobility in the Dutch health insurance market," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 9(3), pages 261-264, August.
    13. 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.
    14. Stefan Greß & Maral Manouguian & Jürgen Wasem, 2007. "Health Insurance Reform in the Netherlands," ifo DICE Report, ifo Institute - Leibniz Institute for Economic Research at the University of Munich, vol. 5(1), pages 63-67, 05.
    15. Schmid, Andreas & Varkevisser, Marco, 2016. "Hospital merger control in Germany, the Netherlands and England: Experiences and challenges," Health Policy, Elsevier, vol. 120(1), pages 16-25.
    16. Wubulihasimu, Parida & Gheorghe, Maria & Slobbe, Lany & Polder, Johan & van Baal, Pieter, 2015. "Trends in Dutch hospital spending by age and disease 1994–2010," Health Policy, Elsevier, vol. 119(3), pages 316-323.
    17. Joan Costa-Font & Valentina Zigante, 2016. "The choice agenda in European health systems: the role of middle-class demands," Public Money & Management, Taylor & Francis Journals, vol. 36(6), pages 409-416, September.
    18. Tsiachristas, A. & Wallenburg, I. & Bond, C.M. & Elliot, R.F. & Busse, R. & van Exel, J. & Rutten-van Mölken, M.P. & de Bont, A., 2015. "Costs and effects of new professional roles: Evidence from a literature review," Health Policy, Elsevier, vol. 119(9), pages 1176-1187.
    19. 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.
    20. van den Berg, Bernard & Van Dommelen, Paula & Stam, Piet & Laske-Aldershof, Trea & Buchmueller, Tom & Schut, Frederik T., 2008. "Preferences and choices for care and health insurance," Social Science & Medicine, Elsevier, vol. 66(12), pages 2448-2459, June.
    21. 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;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(3), pages 287-295, September.
    22. Martin Ineveld & Jeroen Oostrum & Rob Vermeulen & Adri Steenhoek & Joris Klundert, 2016. "Productivity and quality of Dutch hospitals during system reform," Health Care Management Science, Springer, vol. 19(3), pages 279-290, September.
    23. Heinemann, Stephanie & Leiber, Simone & Greß, Stefan, 2013. "Managed competition in the Netherlands—A qualitative study," Health Policy, Elsevier, vol. 109(2), pages 113-121.

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