Health Insurance Reforms and Incentives in the Netherlands

Abstract

Health insurance reform is quite a hot issue in the Netherlands today. For several decades the forming of a national health insurance system has been a major item on the political agenda. However, so far the Netherlands is the only European country in which more than one-third of the population has no compulsory insurance which covers the costs of acute health care such as hospital care, physician services and medicines. In addition to the health insurance reform, the issue of cost containment has become more and more important during the past 20 years. Since the early 1970s the Dutch government have tried to contain health care costs by direct control over prices and productive capacity. As the results of this policy have been disappointing, several proposals were formulated for a structural reform based on a market-oriented approach (see van de Ven 1987). In march 1987 a government-appointed committee presided by Dr. W. Dekker, former president of the Philips company, published its report entitled “Willingness to change”. Two major issues proposed by this Dekker committee were the introduction of a national health insurance (“basic insurance”) and regulated competition between insurers and between providers. After a year of intensive discussion and numerous seminars and conferences, the Dutch government and parliament decided to adopt the main details of the Dekker proposals.