New book analyses a 15-year long reform addressing accessibility, costs, quality and solidarity in the Netherlands
The results, lessons and prospects of a reform of the Dutch health care system which lasted 15 years are compiled in the new book ‘The market reform in Dutch health care’, published today by the European Observatory on Health Systems and Policies.
Authors Patrick Jeurissen from Radboudumc in Nijmegen and Hans Maarse from Maastricht University analyse whether the goals of better accessibility, lower costs, more quality and maximum solidarity have been met since the Dutch embarked upon a reform of their health care system in January 2006.
The reform was based upon the principles of regulated competition, with more freedom of choice and risk-bearing health insurers with opportunities for free purchasing and liberalization of investments by institutions. This unique path of the Netherlands attracted a lot of interest worldwide.
The authors note that in certain areas the gap between theory and practice is large. Institutions compete less heavily than politically inspired images suggest, and under the flag of contract prices and ceiling agreements this led de facto to a new budget system in parts of health care. Mutual market shares between health care providers are shifting only by little.
Since 2012, health care spending has slowed down sharply, relative to the period started and relative to the United States and surrounding countries. Since that year, insurers have also become more risk-bearing and competitive with each other for a low health care premium, aided by covenants in which parties are mutually bound to realize less money for care.
The growth in volume of care has seen a relative decrease, with waiting lists now being seen. Although there is room to diminish inappropriate care, the volume of care will have to increase over time in ageing Dutch society.
The administrative organization of the system is complex and not always clear. The administrative and regulatory burdens are high, indeed higher than in many other countries. Professionals are increasingly confronted with this.
Informing health care system reforms internationally
The Director of the European Observatory on Health Systems and Policies presented the international perspective during the virtual launch of the book.
“The Netherlands is one of the most active reformers, so the Observatory almost always includes it in its comparative work,” Josep Figueras said. “In many countries that we work with, managed competition is often seen as an attractive way to organize the health system. This book shows that running such a system required good data, expertise, and policy capacity – and how the Netherlands made it work. It gives us a fair and realistic account of a complex and innovative health system which we can use in our international work.”