From regulated cartel to regulated competition in the Dutch health care system

Abstract

Health care reform is quite a hot issue in the Netherlands today. Since the early seventies, Government has been trying to contain health care costs by direct control over prices and productive capacities. As the results of this policy were disappointing, several proposals were formulated for a structural reform based on a market-oriented approach. In 1988 the Dutch Government decided to radically reform the financial structure and organization of the health care system. Two major issues are the introduction of a national health insurance (‘basic insurance’) and regulated competition among insurers and among providers. Compared with the last 15 years, this can be considered a 180-degree change-over of health care policy. Because of the revolutionary character of the proposals, one can really speak of a Perestrojka in the Dutch health care system. In this paper the recent developments in the Dutch health care system will be reviewed. First, we will deal with the necessity of change in the Dutch health care system. Then, the main lines of the Government proposals for a new structure of the health care system will be summarized. Finally, the consequences of these proposals for the various parties involved will be discussed.