Dutch Health Care Consumer Panel Research Articles

The role of health insurance literacy in the process and outcomes of choosing an insurance policy

Abstract Background Several countries have healthcare systems that require their citizens to make informed and thoughtful decisions about which health insurance policy fits their needs and preferences best. There are indications that citizens do not always have sufficient skills, so called health insurance literacy (HIL), to do this. This can lead to citizens being sub-optimally insured, suffering inadequate coverage and facing unexpected costs. This study aims to investigate whether the level of HIL among Dutch citizens is related to the way in which they experience the process of choosing a policy, and furthermore whether it is related to their health insurance choices. Methods A mixed-mode questionnaires was distributed to 1,500 participants of the Nivel Dutch Health Care Consumer Panel in February 2020. The response rate was 54% (n = 806). Regression analyses were performed to gain a better understanding of the association of HIL with the process and outcomes regarding the choice of a health insurance policy. Results Respondents with a low HIL, in comparison to those with a high HIL, find choosing a health insurance policy more often difficult, not interesting, and boring, and less often consider it important and worthwhile (p < 0.01 for all). Also, they make less use of their opportunity to switch from one health insurer to another (p < 0.05). However, they do opt for a supplementary insurance policy and a voluntary deductible to the same extent as respondents with a high HIL. Conclusions The level of HIL among Dutch citizens is related to the way they experience the process of choosing a health insurance policy, and to the extent to which they switch from one health insurer to another, but not to their health insurance choices. It is important to get a better understanding of the barriers citizens with a low HIL experience during this process, and of their needs and preferences. Key messages • The level of HIL is related to the way Dutch citizens experience the process of choosing a health insurance policy. • Compared to those with a high HIL, Dutch citizens with a low HIL switch health insurers less often, but opt for a supplementary policy and a voluntary deductible to the same extent.

The role of health insurance literacy in the process and outcomes of choosing a health insurance policy in the Netherlands

In several countries, citizens are expected to be critical consumers when choosing a health insurance policy. However, there are indications that citizens do not always have the sufficient skills, so called health insurance literacy (HIL), to do this. We investigated whether the level of HIL among Dutch citizens is related to the way in which they experience the process of choosing a policy, and furthermore whether it is related to their health insurance choices. We obtained information by sending questionnaires to members of the Nivel Dutch Health Care Consumer Panel in 2020. Of the 1,500 approached, 806 panel members participated (response rate 54%). Our results indicate that, compared to those with a high HIL, respondents with a low HIL more often find choosing a health insurance policy difficult, not interesting, and boring, and less often consider it important and worthwhile. Furthermore, they make less use of the opportunity to switch from one health insurer to another. However, they do still opt for a supplementary insurance policy and a voluntary deductible to the same extent as citizens with a high HIL. We conclude that the HIL level among Dutch citizens is related to the way in which they experience the process of choosing a health insurance policy and to the extent to which they switch from one insurer to another. But it is not related to their health insurance choices. Follow-up research should focus on how citizens with a low HIL can be better supported when choosing a health insurance policy.

The impact of trust in healthcare and medication, and beliefs about medication on medication adherence in a Dutch medication-using population

IntroductionTrust in healthcare and medication, defined as feelings of reassurance and confidence in the healthcare system or medication, may be a key prerequisite before engaging in the use of medication. However, earlier studies have focussed on beliefs about medication rather than trust as predictors of medication adherence. This study therefore aims to simultaneously explore the relationship of trust in healthcare, medication and beliefs about medication, with medication adherence. MethodsIn a cross-sectional study, an online questionnaire was sent out to 1500 members of the Dutch Health Care Consumer Panel of Nivel in November 2018. Respondents were asked to grade their level of trust in healthcare and medication (scale 1–10). The Beliefs About Medicines Questionnaire (BMQ) for general and specific medication beliefs was used to address beliefs, the Medication Adherence Report Scale (MARS-5) to measure medication adherence. Data were analysed using structural equation modelling (SEM) with a backward stepwise approach. Out of 753 people that completed the questionnaire, 407 people used prescription medication and were included in the analyses. ResultsA positive association between trust in medication and medication adherence was found (0.044, p < 0.05). BMQ subscales Overuse (−0.083, p < 0.05), Necessity (0.075, p < 0.05) and Concerns (−0.134, p < 0.01) related with medication adherence. BMQ subscale Harm did not relate to medication adherence. ConclusionTrust in medication and beliefs about medication were both individually associated with medication adherence. Healthcare providers should therefore not only focus on patients' medication beliefs, but also on strengthening patients' trust in medication to improve medication adherence.

Preferred Conversation Topics with Respect to Treatment Decisions Among Individuals with Type 2 Diabetes.

Greater knowledge of individuals' needs and preferences can enhance shared decision-making, which is associated with improved quality of decisions and increased satisfaction. This study aimed to identify and prioritize the attributes (ie conversation topics) that individuals with type 2 diabetes find it most important to discuss with their healthcare provider regarding treatment decisions. First, small group interviews were organized with adults with type 2 diabetes (N=8) treated in primary care to identify the attributes that they find important to discuss regarding treatment decisions. A five-step nominal group technique was applied during the interviews. An object best-worst scaling (BWS) survey was subsequently distributed to individuals with self-reported diabetes participating in the Dutch Health Care Consumer Panel of the Netherlands Institute for Health Services Research (N=600) to determine the relative importance score (RIS) of the identified attributes. A higher RIS indicates a higher level of perceived importance. Subgroup and latent class analyses were performed to explore whether individuals' demographic and disease characteristics influenced their attribute preferences. A total of 21 attributes were identified during three small group interviews with individuals with type 2 diabetes. Respondents in the BWS survey (N=285) viewed "quality of life" (RIS=11.97), "clinical outcomes" (RIS=10.40), "long-term diabetes complications" (RIS=9.83) and "short-term adverse medication" (RIS=7.72) as the most important in the decision-making process for the treatment of type 2 diabetes. Some differences in attribute preferences were identified according to demographic and disease characteristics. In general, individuals with type 2 diabetes not only want to discuss the biological effects of treatments, but also the impact of treatment on their quality of life. Healthcare providers should be aware that attributes are viewed differently by different individuals. This emphasizes the need for tailor-made healthcare decisions, which means eliciting and responding to individual preferences in the decision-making process.

Perceived Importance of the Benefits and Harms of Colorectal Cancer Screening: A Best-Worst Scaling Study

ObjectivesTo elicit the relative importance of the benefits and harms of colorectal cancer (CRC) screening among potential screening participants in the Dutch population. MethodsIn a consensus meeting with 11 experts, risk reduction of CRC and CRC deaths (benefits) and complications from colonoscopy, stress of receiving positive fecal immunological test (FIT) results, as well as false-positive and false-negative FIT results (harms) were selected as determinant end points to consider during decision making. We conducted an online best-worst scaling survey among adults aged 55 to 75 years from the Dutch Health Care Consumer Panel of The Netherlands Institute for Health Services Research to elicit preference values for these outcomes. The preference values were estimated using conditional logit regression. ResultsOf 265 participants, 234 (89%) had ever participated in CRC screening. Compared with the stress of receiving a positive FIT result, the outcome perceived most important was the risk of CRC death (odds ratio [OR] 4.5; 95% confidence interval [CI] 3.9-5.1), followed by risk of CRC (OR 4.1; 95% CI 3.6-4.7), a false-negative FIT result (OR 3.1; 95% CI 2.7-3.5), colonoscopy complications (OR 1.6; 95% CI 1.4-1.8), and a false-positive FIT result (OR 1.4; 95% CI 1.3-1.6). The magnitude of these differences in perceived importance varied according to age, educational level, ethnic background, and whether the individual had previously participated in CRC screening. ConclusionDutch men and women eligible for FIT-based CRC screening perceive the benefits of screening to be more important than the harms.

Measuring Health Insurance Literacy in the Netherlands – first results of the HILM-NL questionnaire

Abstract Background Many Western countries have healthcare systems that expect their citizens to make critical, well-considered decisions about which health insurance policy best fits their needs and preferences. There are indications that citizens struggle to fulfil this role due to the complexity of the healthcare systems and lack of skills, support or motivation. This can lead to citizens being sub-optimally insured, suffering inadequate coverage and facing unexpected costs. To understand how citizens choose and use a policy, the health insurance literacy measure (HILM) was developed in the US. It seems valuable to investigate the concept of Health Insurance Literacy (HIL) in other countries. This study aims to examine how HIL is distributed among citizens in the Netherlands; and to find out whether certain groups have more difficulty choosing and using a health insurance policy. Methods We measured HIL using the HILM-NL questionnaire, a validated and translated version of the HILM. In February 2020, the HILM-NL was sent to 1,500 members of the Nivel Dutch Health Care Consumer Panel. The response rate was 54% (n = 806). Higher HILM-NL scores imply a higher self-assessed ability in choosing and using health insurance. Results There is a wide variation in HIL among citizens in the Netherlands. The average total HILM-NL score is 55.14 (ranging from 21-84). Lower-educated citizens (p&amp;lt;.04) and citizens with lower income (p&amp;lt;.01) are relatively more likely to have lower HIL, than, respectively, higher-educated citizens and citizens with higher income. Conclusions Citizens who completed less education or earn a lower income are relatively more likely to have difficulty choosing and using a health insurance policy. It is important to support these vulnerable groups, so that Dutch citizens in general will be better able to choose a policy that fits their needs and preferences. This should ensure that citizens are less likely have to deal with inadequate coverage and unexpected costs. Key messages • There is a wide variation in HIL among citizens in the Netherlands. • Citizens who completed less education or earn a lower income are relatively more likely to have difficulty choosing and using a health insurance policy.

Citizens’ perspective on ‘the right care in the right place’

Abstract Background Healthcare systems around the globe are facing challenges, from increasing demand and costs to a diminishing health workforce. Without change, healthcare will become unsustainable. In the Netherlands, the government aims to organize sustainable healthcare by among others the policy ‘the right care in the right place’. An important part of this policy is relocating healthcare, for instance, from the hospital to the general practitioner (GP) or from the GP to other healthcare providers or to citizens themselves. Relocation of care is expected to reduce costs and manpower shortages. There is, however, little known about how citizens think about this topic, although they are an important stakeholder. This research aims to investigate citizens’ perspectives on the right place for care. Methods A questionnaire was sent in December 2021 to 1.500 members of Nivel's Dutch Healthcare Consumer Panel, including 4 questions about the right care in the right place. The response was N = 796 (53%). In addition, two citizen platforms were organized in March 2022, to discuss the right care in the right place. A total of 23 citizens participated. Results First results indicate that most citizens related expertise and accessibility to the right care in the right place. Participants said that non-complex care could be relocated from the hospital to the GP if the GP has the right expertise. Expertise was mentioned as the most important aspect of care delivery. According to participants, care could be shifted from the GP to other primary care professionals, to social services or to self-sustainability, given that citizens know who to visit or what to do with health problems/worries. More results will be available by November. Conclusions Relocating care could be a possible solution to keep healthcare sustainable in the future in terms of costs and manpower. Among citizens, there seems to be support when certain conditions are met. Key messages • Citizens support the substitution of non-complex care from hospitals. • Citizens are willing to improve self-sustainability when they have the tools.

Measuring health insurance literacy in the Netherlands – First results of the HILM-NL questionnaire

BackgroundThere are several indications that citizens in the Netherlands struggle to make critical, well-considered decisions about which insurance policy best fits their needs and preferences. This can lead to citizens being sub-optimally insured, facing unexpected costs or suffering inadequate coverage. This study aims to examine how health insurance literacy (HIL) is distributed among citizens in the Netherlands; and to find out whether there are certain groups who have more difficulty choosing and using a health insurance policy. MethodsWe measured health insurance literacy using the HILM-NL questionnaire, the validated Dutch version of the original health insurance literacy measure (HILM). In February 2020, the HILM-NL was sent to 1,500 members of the Nivel Dutch Health Care Consumer Panel. The response rate was 54% (806). ResultsThere is a wide variation in HIL among citizens in the Netherlands. The average total HILM-NL score is 55.14 (on a range of 21–84). The level of education and the household net income are significantly related to HIL. ConclusionsCitizens who completed less education or earn a lower income are relatively more likely to have difficulty choosing a health insurance policy or using policy benefits to pay for health services once enrolled. It is important to support these vulnerable groups properly in their choice and use of a health insurance policy.

Health insurance literacy in the Netherlands: The translation and validation of the United States' Health Insurance Literacy Measure (HILM).

An important criterion for the proper functioning of a managed competition healthcare system, such as operates in the Netherlands, is that all citizens can make well-informed decisions regarding their health insurance policy. In order to achieve this, citizens need certain health insurance literacy skills. It is not known how far citizens in the Netherlands have these skills. The aim of this study is to provide a reliable instrument that measures the health insurance literacy of citizens in the Netherlands. It would be based upon an existing instrument developed in the US. We translated the US Health Insurance Literacy Measure (HILM) into Dutch. Furthermore, we established the psychometric properties of the Dutch version (HILM-NL), and we validated the HILM-NL in a general population sample by sending surveys to members of the Nivel Dutch Health Care Consumer Panel (DHCCP) in February and March 2020. The response rates were respectively 54% (n = 806) and 56% (n = 595). No insurmountable difficulties with equivalence were encountered throughout the translation process. The HILM-NL showed an acceptable level of internal consistency, good test-retest reliability, and a good construct validity. The HILM-NL is a reliable instrument for measuring health insurance literacy among citizens in the Netherlands. With this instrument, it is better possible both to assess how these citizens choose and use a health insurance policy, and also the difficulties they face. It enables citizens in the Netherlands to be supported better in making well-informed decisions on health insurance.

Does supplementary health insurance play a role in the switching behaviour of citizens in the Netherlands?

ABSTRACT Background: Several healthcare systems have elements of managed competition in which citizens can choose between multiple insurers. In order for this principle to function properly, all citizens should have equal opportunities to switch insurer. Studies, conducted around 2015, have shown that the supplementary insurance policy is perceived by citizens as a barrier to switching, which could have negative consequences for the intended goals of the system. We aim to explore whether a supplementary insurance policy still has a restraining role on the opportunity to switch among citizens in the Netherlands from 2015 to 2020. Furthermore, we will examine if the extensiveness of the supplementary insurance policy relates to the switching behaviour of citizens. This element has not been addressed in previous studies. Methods: We obtained information on the role of the supplementary health insurance policy in the switching behaviour of citizens by sending questionnaires, yearly in February from 2015–2020, to 1,500 members of the Dutch Health Care Consumer Panel (DHCCP) each year. As such, we were able to examine whether having a supplementary insurance policy plays a role in the decision of Dutch citizens to switch insurer. The response rates were consecutively from 2015 to 2020: 60% (n = 896), 47% (n = 703), 44% (n = 659), 50% (n = 751), 48% (n = 715), and 54% (n = 806). Results: Citizens with a supplementary insurance policy switch less often than citizens without one. The extensiveness of the supplementary insurance policy is significantly associated with the decision of citizens to switch insurer; the more extensive citizens are insured, the less often they switch. Additionally, our results show that every year a small group of citizens does not switch insurer because they are concerned that they will not be accepted for a supplementary insurance policy. Conclusions: Our results indicate that having a supplementary insurance policy holds citizens back from using their opportunity to switch. This contributes to the idea that having a supplementary insurance policy could be experienced by citizens as a barrier to switch. This raises questions about the extent to which the principle of managed competition in the Dutch healthcare system works as intended.

The Importance of Choosing a Health Insurance Policy and the Ability to Comprehend That Choice for Citizens in the Netherlands.

Background:In a health insurance system based on managed competition, such as in the Netherlands, it is important that all citizens can make well-informed decisions on which policy fits their needs and preferences best. However, partly due to the large variety of health insurance policies, there are indications that a significant group of citizens do not make rational decisions when choosing a policy.Objective:This study aimed to provide more insight into (1) how important it is for citizens in the Netherlands to choose a health insurance policy and (2) how easy it is for them to comprehend the information they receive.Methods:Data were collected by sending a survey to members of the Nivel Dutch Health Care Consumer Panel in February 2017. The response rate was 44% (N = 659).Key Results:Our results indicate that citizens in the Netherlands acknowledge the importance of choosing a health insurance policy, but they also point out that it is difficult to comprehend health insurance information.Conclusion:Our findings suggest that a section of the citizens do not have the appropriate skills to decide which insurance policy best fits their needs and preferences. Having better insight into their level of health insurance literacy is an important step in the process of evaluating the extent to which citizens can fulfill their role in the health insurance system. Our results suggest that it is important to better tailor information on health insurances to the specific needs and skills of the individual. By doing this, citizens will be better supported in making well-informed decisions regarding health insurance policies, which should have a positive effect on the functioning of the Dutch health insurance system. [HLRP: Health Literacy Research and Practice. 2021;5(4):e287–e294.]Plain Language Summary:The number of health insurance policy options to choose from is extensive in the Netherlands. This study explored to what extent citizens in the Netherlands find it important to choose a health insurance policy, and to what extent they comprehend the information they receive. The data were collected in 2017 using the Nivel Dutch Health Care Consumer Panel.

Relationship between trust and patient involvement in medical decision-making: A cross-sectional study.

Patients vary in their preferences regarding involvement in medical decision-making. Current research does not provide complete explanation for this observed variation. Patient involvement in medical decision-making has been found to be influenced by various mechanisms, one of which could be patients' trust in physicians. The aim of this study was to examine whether trust in physicians fosters or impairs patient involvement in medical decision-making. This study also aimed to determine to what extent the relationship between trust and preferences regarding decision-making roles was influenced by the sociodemographic characteristics of the patients. We hypothesised that trust can both foster and impair patient involvement in medical decision-making. A survey was sent out to members of the Nivel Dutch Health Care Consumer Panel in February 2016 (response rate = 47%, N = 703). The Wake Forest Physician Trust Scale was used to measure trust. Patient involvement was measured using two items based on the study published by Flynn and colleagues in 2006. Multiple regression analysis was used to analyse the relationship between trust and patient involvement. We found a negative relationship between trust and patient involvement in medical decision-making in men. Women with high trust reported to be more involved in medical decision-making compared to men with high trust. The results suggest that trust impairs involvement in medical decision-making for men but not for women. Further research could provide a more comprehensive explanation of the variation in patient preferences regarding involvement in medical decision-making to further elucidate which underlying mechanisms could enhance patient participation.

Using Different Cutoffs to Define Tinnitus and Assess Its Prevalence-A Survey in the Dutch General Population.

Introduction: Tinnitus prevalence numbers in the literature range between 5 and 43%, depending on the studied population and definition. It is unclear when tinnitus becomes pathologic.Objectives: To assess the tinnitus prevalence in the Dutch general population with different cutoffs for definition.Methods: In this cross-sectional study, a questionnaire was sent to a sample (n = 2,251) of the Nivel (Netherlands Institute for Health Services Research) Dutch Health Care Consumer Panel. Three questions were asked to assess the presence of tinnitus, duration, and frequency of the complaint. We classified people as having pathologic tinnitus when participants experienced it for 5–60 min (daily or almost daily or weekly), or tinnitus for >60 min or continuously (daily or almost daily or weekly or monthly), so tinnitus impact on daily life was measured with the Tinnitus Functional Index (TFI) and a single-item question. Answers were stratified to mid-decade years of age. Prevalence numbers were weighted by gender and age to match the Dutch population.Results: Nine hundred thirty-two of 2,251 participants (41%) filled out the questionnaire. The median age was 67.0 (IQR 17) years. Three hundred thirty-eight of 932 (36%) experienced tinnitus for an undefined amount of time during the last year. Two hundred sixteen of 932 (23%) met our definition of having pathologic tinnitus (21% when weighted for age and gender). The median TFI score for all pathologic tinnitus participants was 16.6 (IQR 21.8). A percentage of 50.4% of the pathologic tinnitus participants had a TFI in the range 0–17, which can be interpreted as not a problem.Conclusion: Twenty-three percent (unweighted) or 21% (weighted) of our sample met our definition of pathologic tinnitus, which was based on a combination of duration and frequency over the last year. The TFI score of 47.7% of the pathologic tinnitus participants is ≥18. This indicates that they consider the tinnitus to be at least “a small problem” [11.1% (unweighted) or 8.9% (weighted) of the total study group]. This study illustrates the difficulties with defining pathologic tinnitus. In addition, it demonstrates that tinnitus prevalence numbers vary with different definitions and, consequently, stresses the importance of using a uniform definition of tinnitus.

Features of a Patient Portal for Blood Test Results and Patient Health Engagement: Web-Based Pre-Post Experiment.

BackgroundThe use of patient portals for presenting health-related patient data, such as blood test results, is becoming increasingly important in health practices. Patient portals have the potential to enhance patient health engagement, but content might be misinterpreted.ObjectiveThis study aimed to discover whether the way of presenting blood test outcomes in an electronic patient portal is associated with patient health engagement and whether this varies across different blood test outcomes.MethodsA 2x3 between-subjects experiment was conducted among members of the Nivel Dutch Health Care Consumer Panel. All participants read a scenario in which they were asked to imagine themselves receiving blood test results. These results differed in terms of the presented blood values (ie, normal vs partially abnormal vs all abnormal) as well as in terms of whether the results were accompanied with explanatory text and visualization. Patient health engagement was measured both before (T0) and after (T1) participants were exposed to their fictive blood test results.ResultsA total 487 of 900 invited members responded (response rate 54%), of whom 50.3% (245/487) were female. The average age of the participants was 52.82 years (SD 15.41 years). Patient health engagement saw either a significant decrease or a nonsignificant difference in the experimental groups after viewing the blood test results. The mean difference was smaller in the groups that received blood test results with additional text and visualization (meanT0 5.33, SE 0.08; meanT1 5.14, SE 0.09; mean difference 0.19, SE 0.08, P=.02) compared with groups that received blood test results without explanatory text and visualization (meanT0 5.19, SE 0.08; meanT1 4.55, SE 0.09; mean difference 0.64, SE 0.08, P<.001). Adding text and visualization, in particular, reduced the decline in patient health engagement in participants who received normal results or mixed results (ie, combination of normal and abnormal results).ConclusionsAdding text and visualization features can attenuate the decrease in patient health engagement in participants who receive outcomes of a blood test via a patient portal, particularly when blood test results are (partly) normal. This suggests that explanatory text and visualization can be reassuring. Future research is warranted to determine whether these results can be generalized to a patient population who receive their actual blood test results.

How does the general public balance convenience and cognitive pharmaceutical services in community pharmacy practice.

Community pharmacy is shifting its focus from traditional, product-focused roles to the provision of cognitive pharmaceutical services (CPS). Previous research has indicated that community pharmacists predominantly want to devote their capacity to CPS. Ideally, services provided also address users' needs. The general public's preferences regarding the services provided by community pharmacists are currently less understood. This study investigates the general public's preferences and perceived importance of CPS versus convenience in community pharmacy practice. An online survey of 1.500 members of the Dutch Health Care Consumer Panel containing questions regarding preferences for CPS and convenience was distributed. Descriptive statistics and linear regression analysis were performed to investigate the relationship between preferences and participant characteristics. 516 panel members completed all questions regarding preferences and importance of the availability of services. The majority preferred convenience (68.2%) and a smaller proportion preferred CPS (27.7%). However, participants considered it important from a societal viewpoint that CPS is provided (45.0%). Participants who preferred CPS over convenience were generally older (p<0.001) and used more medicines (p<0.001). Convenience of community pharmacy services is most preferred by the general public. However, CPS is perceived as important, especially for elderly who use more medicines. Elderly patients who use more medicines more often rate CPS as more important than convenience. These findings suggest that community pharmacists should ensure that pharmacy logistics are organized efficiently before focusing on the provision of CPS.

Does the chronically ill population in the Netherlands switch their health insurer as often as the general population? Empirical evidence from a nationwide survey study

BackgroundConsumer mobility is an important aspect of a health insurance system based on managed competition. Both the general population and insured with a chronic illness should enjoy an equal opportunity to switch their insurer every year. We studied possible differences in the rates of switching between these two groups in the Netherlands.MethodsA structured questionnaire was sent to 1500 members of Nivel’s Dutch Health Care Consumer Panel (response rate: 47%) and to 1911 chronically ill members of the National Panel of the Chronically ill and Disabled (response rate: 84%) in February 2016. Associations between switching and background characteristics were estimated using logistic regression analyses with interaction effects.ResultsIn general, we did not find significant differences in switching rates between the general population and chronically ill population. However, a combination of the population and background characteristics demonstrated that young insured with a chronic illness switched significantly less often than young insured from the general population (1% versus 17%).ConclusionsOur results demonstrated that the group of young people with a chronic illness is less inclined to switch insurer. This observation suggests that this group might either face difficulties or barriers which prevents them from switching, or that they experience a high level of satisfaction with their current insurer. Further research should therefore focus on unravelling the mechanisms which explain the differences in switching rates.

Role of supplementary health insurance in switching behaviour of consumers in the Netherlands

Background The healthcare systems of several countries have elements of managed competition in which consumers can choose between multiple insurers. The goal of a healthcare system based on managed competition is that it maintains the quality of care while keeping it accessible for all. In order to let the principle of managed competition function properly, all consumers should have equal opportunities to switch insurer. There are indications that some consumers experience barriers to switch, which could have negative consequences for the intended goals of the system. Aim This study aims to explore the role of the supplementary health insurance in the switching behaviour of consumers in the Netherlands. Dutch citizens are obliged to take out a basic insurance and can opt for supplementary insurance. Due to rising costs, policy could be directed at limiting the coverage of the basic insurance causing the supplementary insurance to become more important. Methods Questionnaires have been sent to 1,500 members of the Dutch Health Care Consumer Panel (DHCCP) in February 2017 and 1,854 members of the National Panel of the Chronically Ill and Disabled (NPCD) in April 2017. The response rates were respectively 44% (n = 659) and 86% (n = 1,593). Results In the general population, 6% of the consumers with a supplementary insurance switched insurer, while 16% of the consumers without a supplementary insurance switched. Chronically ill and disabled consumers with a supplementary insurance switched less, namely 5%. Reasons why consumers do not switch are now further analyzed. Conclusions Preliminary results show that consumers with a supplementary insurance switch less often than consumers without a supplementary insurance. Potential reasons for this finding are that consumers with a supplementary insurance are more risk averse and rather avoid the decision to switch. This might imply that the principle of managed competition in the Dutch healthcare system does not work entirely as intended. Key messages: Having a supplementary insurance can hold consumers back to switch from insurer. The supplementary insurance can have implications for how the system of managed competition works.

Solidarity in the Dutch healthcare system: monitoring trends in willingness to pay

Background Increasing costs of healthcare are putting stress on solidarity principles in social health insurance in European countries. This could pose a threat to equal access to healthcare which can have negative consequences for national health. There have been policy changes to tackle rising costs which alter solidarity in the healthcare system and spark a debate on how resources should be distributed. Institutionalized solidarity principles rely on a broad societal support for equal access to healthcare. A decrease in public support might affect solidarity in healthcare systems. Aim The aim of this research is to monitor solidarity in Dutch society. The focus is on willingness to pay for healthcare costs for others through the years. Methods Questionnaires have been sent out to a random selection of the 12.000 members of Nivel’s Dutch Health Care Consumer Panel, and included, among others, questions about solidarity in healthcare. Data are available from 2013, 2015 and 2017. The response was N = 764 (51%), N = 633 (42%) and N = 668 (45%) respectively. Results In 2017 74% of the respondents stated that they were willing to pay for others, compared to 73% in 2013 and 63% in 2015. If we look at willingness to pay for certain groups the results are similar over time: people show more solidarity towards others when others experience health issues beyond their ‘control’ like a genetic disposition. People show les solidarity when others face health problems due to lifestyle choices like excessive smoking and drinking. Results show time trends, especially for certain groups that have low education or poor health. Conclusions Results show that the willingness to pay for others is high; thus reflecting a high degree of solidarity. However, there is less solidarity for certain groups and attitude is changing over time. Since social health insurance is based on a broad societal support for equal access to healthcare it is paramount to keep monitoring solidarity and see if trends continue. Key messages Willingness to pay for healthcare costs for others is high; showing high degree of solidarity over time. There are trends in willingness to pay which could affect solidarity in healthcare systems.

Community participation in primary care: willingness to participate, a web survey in the Netherlands.

Community participation in primary care refers to involvement of community members in the organization, governance and policy making of primary care facilities. Due to demographic changes and changes in the role of patients and the community concerning health care, it becomes important to include the social environment of patients into healthcare. Community participation may help GPs to improving their practice and providing care according to the needs of the population. Interpreted this way, it may be an important contributor to quality of care. In 2016, a web questionnaire was send to 800 members of the Dutch Health Care Consumer Panel. The response rate was 34%. Willingness to participate was divided into perceived readiness, ability and time to participate. The data were analysed using frequency tables and linear regression analysis.FindingsHalf of the participants were ready to give their opinion on primary care and one-third reported willingness to participate in decision making. Participants were less optimistic about their ability to participate and the time they have available for participation. Readiness and perceived ability were mainly determined by the importance that the respondents attributed to participation. Participants with previous experience in volunteering appeared more willing to spend time on participation. This study showed that half of the respondents are willing to participate, but they are less sure about their ability to do so and that finding time to participate is seen as problematic. Future research should focus on which characteristics influence willingness. This knowledge might help primary care facilities to recruit people more easily and successfully.

Does shared decision-making reduce antibiotic prescribing in primary care?

Increasing antibiotic resistance is recognized as a major threat to global health and is related to antibiotic prescription rates in primary care. Shared decision-making (SDM), the process in which patients and doctors participate together in making decisions, is argued to possibly promote more appropriate use of antibiotics and reduce prescribing. However, it is unknown whether in practice fewer antibiotics are prescribed where more SDM takes place. To investigate whether more SDM is related to less antibiotic prescribing and whether this relationship differs between subgroups of patients (male/female and age groups). A questionnaire survey was conducted among 2670 members of the Dutch Health Care Consumer Panel to measure SDM (response rate 45%). Average practice-level SDM scores were calculated for 15 general practices. Data from routine electronic health records of 8192 adult patients of these general practices participating in the Nivel Primary Care Database were used to assess relevant illness episodes (acute cough, acute rhinosinusitis and urinary tract infection), the indication for antibiotics and antibiotic prescriptions. Logistic multilevel regression analyses were performed to investigate the relationship between practice-level SDM and patient-level antibiotic prescriptions. In practices where more SDM takes place, general practitioners prescribed fewer antibiotics for adult patients under the age of 40 years in preference-sensitive situations (i.e. situations in which antibiotics could be considered according to clinical guidelines). SDM can be a framework to reduce the prescribing of antibiotics and thus to control antibiotic resistance.