Enrollees are positive about selective contracting, but not if it limits their freedom of choice

Abstract

Background: In the last decades, health care systems in several European countries changed from a supply-oriented system to a demand-oriented system based on managed competition. In The Netherlands managed competition was introduced in 2006. Health insurers are allowed to selectively contract care providers. The idea is that this will improve health care quality and reduce costs. Health insurers are now starting to implement selective contracting, thus limiting provider choice for enrollees. Insurance premiums may be lower for policies with limited choice, but copayments are asked when going to a provider without a contract. It is important that enrollees are aware of this to avoid unexpected costs, but are they? And are health insurers transparent about this? Methods: In March 2011, 2000 questionnaires were sent to members of the Healthcare Consumer Panel (response 74%). Respondents were asked whether they were familiar with the concepts ‘healthcare purchasing’, ‘selective contracting based on price’ and ‘selective contracting based on quality’. Also, they were asked their opinion on several aspects of selective contracting. In addition, customer services of 28 health insurers were sent e-mails in which they were asked if they selectively contract hospitals and on what basis. Results: It was found that most enrollees (87%) were not familiar with one or more of the concepts. They did find the principle of selective contracting appealing and they also had trust in their health insurer to purchase good quality care for a good price. Yet, they did not want selective contracting to limit their freedom of provider choice. A third of the health insurers was not clear about their purchasing strategy in their e-mail reply, despite of being explicitly asked about it. Conclusions: The fact that many enrollees were not familiar with the concepts points at a lack of knowledge. The finding that enrollees are positive about selective contracting, but do not want their freedom of choice to be limited hints at the importance of choice to enrollees. Interesting questions are how many choice options do enrollees want and are they willing to pay for freedom of choice? And are there alternatives for selective contracting in order to reach similar goals?