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Vertical relationships between health insurers and healthcare providers


  • Michiel Bijlsma

    () (CPB Netherlands Bureau for Economic Policy Analysis)

  • Arno Meijer

    (CPB Netherlands Bureau for Economic Policy Analysis)

  • Victoria Shestalova

    (CPB Netherlands Bureau for Economic Policy Analysis)


The current institutional reforms in the Dutch healthcare sector may increase the extent of vertical relations (such as vertical contracts and vertical integration) between insurers and healthcare providers. Vertical relations may have both welfare increasing and welfare reducing effects. In this study, we focus on the latter, in particular on anticompetitive foreclosure. We distinguish three possible mechanisms that may lead to anticompetitive foreclosure, called respectively 'exclusivity', 'sabotage', and the 'waterbed effect'. We discuss under which conditions they come into play and which policy measures can prevent them.

Suggested Citation

  • Michiel Bijlsma & Arno Meijer & Victoria Shestalova, 2008. "Vertical relationships between health insurers and healthcare providers," CPB Document 167, CPB Netherlands Bureau for Economic Policy Analysis.
  • Handle: RePEc:cpb:docmnt:167

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    Cited by:

    1. 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.

    More about this item

    JEL classification:

    • D4 - Microeconomics - - Market Structure, Pricing, and Design
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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