Selective contracting: a key element of the Dutch health care reforms. Vertragsfreiheit: ein sinnvoller weg fur das Schweizer Gesundheitswesen? Zurich, 13jan05 Wynand P.M.M. van de Ven Professor of Health Insurance Department of Health Policy and Management Erasmus University Rotterdam.
Vertragsfreiheit: ein sinnvoller weg fur das Schweizer Gesundheitswesen?
Wynand P.M.M. van de Ven
Professor of Health Insurance
Department of Health Policy and Management
Erasmus University Rotterdam
1865: Act on Medical Licenses
1941: Sickness Fund Act
1968: Exceptonal Medical Expenditures Act
1971: Hospital Facilities Act
1982: Health Care Tariffs Act
1985: Health Care Facilities Act
1986: Act on Access to private health insurance
1988: “Dekker Reforms”
1998: New Competition Act
National Health Insurance for Catastrophic Risks (AWBZ)
- among insurers;
- among providers of care.
Provider of care
risk adjusted premium subsidy
The rationale is to stimulate the sickness funds to improve efficiency in health care production and to respond to consumers’ preferences.
Who is the third-party purchaser of care:
In the first option it is hard to think of any rational argument for giving consumers a periodic choice among risk-bearing sickness funds.
According to the declaration of policy of the
Dutch government (May 2003):
“The central planning by government has failed and will be replaced by regulated competition as soon as justifiable”.
With these last 4 words, government on the one hand stresses the urgent need for reform and on the other hand indicates that not all preconditions for regulated competition are yet fulfilled.
If the premium subsidies are based on only age and gender, then an insurer will, roughly speaking, make:
limited provider plans (HMOs/PPOs);
other managed care techniques;
design of benefits package;
supplementary health insurance;
virtual (internet) sickness fund;
employer-related (group) sickness fund.Selection activities
Selection may threaten