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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)

Registered author(s):

    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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    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
    Contact details of provider: Web page: http://www3.interscience.wiley.com/cgi-bin/jhome/5749

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    1. Maarse, J. A. M., 1989. "Hospital budgeting in Holland: aspects, trends and effects," Health Policy, Elsevier, vol. 11(3), pages 257-276, June.
    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. 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.
    4. 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.
    5. 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.
    6. 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.
    7. 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.
    8. 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.
    9. Lieverdink, Harm & Maarse, Hans, 1995. "Negotiating fees for medical specialists in the Netherlands," Health Policy, Elsevier, vol. 31(2), pages 81-101, February.
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