Managed competition in health care in the Netherlands and Germany: Theoretical foundation, empirical findings and policy conclusions

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Private health insurance in social health insurance countries: Market outcomes and policy implications

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Aging, Pensions and Long-term Care: What, Why, Who, How?; Comment on “Financing Long-term Care: Lessons From Japan”

Japan has been aging faster than other industrialized nations, and its experience offers useful lessons to others. Japan has been willing to expand its welfare state with a long-term care (LTC) insurance to finance home care and nursing home care for frail elderly. As Ikegami shows, it created new facilities and expanded specialized staffing for home care, developed a country-wide assessment system and shifted responsibilities between the central and local authorities over that assessment and the determination of co-payments for LTC. Faced with rapid growth in demand for LTC, the government felt the need for new cost control measures. The Japanese experience illustrates that new social policies take time to develop. There is often a need to adjust. But there are also other lessons. The main one is that there is no direct relation between the degree of population aging and total health spending. While aging requires adjustments in the organization of care, and expanding LTC for frail elderly, international studies show there is no need to worry about the ‘unaffordability’ of aging. In this commentary, we have framed four “What, Why, Who, and How” questions about LTC to (re-)define the borderlines between public and private responsibilities for the range of activities for which some (but certainly not all) frail elderly as well as many non-elderly require support in daily life

Swiss and Dutch “consumer-driven health care”: ideal model or reality?

This article addresses three topics. First, it reports on the international interest in the health care reforms of Switzerland and The Netherlands in the 1990s and early 2000s that operate under the label “managed competition” or “consumer-driven health care.” Second, the article reviews the behavior assumptions that make plausible the case for the model of “managed competition.” Third, it analyze the actual reform experience of Switzerland and Holland to assess to what extent they confirm the validity of those assumptions. The article concludes that there is a triple gap in understanding of those topics: a gap between the theoretical model of managed competition and the reforms as implemented in both Switzerland and The Netherlands; second, a gap between the expectations of policy-makers and the results of the reforms, and third, a gap between reform outcomes and the observations of external commentators that have embraced the reforms as the ultimate success of “consumer-driven health care.” The article concludes with a discussion of the implications of this “triple gap”

Recent Changes in Dutch Health Insurance: Individual Mandate or Social Insurance?

Dutch health insurance changed dramatically in 2006 with the abolition of the sick fund insurance that had covered wage earners and their dependents for over hundred years. In 2005, with surprisingly little political debate or public opposition, the Dutch Parliament passed a law introducing a new form of population-wide health insurance that replaced the former public and private health insurance systems. In essence, the law was similar to earlier proposals of the 1980s and 1990s that failed to gain lasting public and political support, but it meant a further push towards privatization of Dutch health insurance. As of January 2006, all residents of the Netherlands have to take out health insurance with one of the forty or so insurers of their own choice. Insurers have to accept any applicant for the government-determined basic coverage. Half of insurers ’ income consists of the income-related contribution that employers withhold as earmarked taxation, channeled to insurers through a central fund under the authority of the tax department. For the remaining 50 percent, insured persons pay a flat rate premium directly to their insurer, and patients pay modest amounts of user fees. Low-income groups—amazingly, for this purpose, 40 percent of the population counts as low income—can apply for a fiscal subsidy. Enthusiastically, a lengthy front-page article in the Wall Street Journal sees the Dutc

Vers une nouvelle architecture de la protection sociale en Europe: une contribution de la présidence belge

status: publishe

Coordination ouverte: entre science et politique?

status: publishe