Is de marktwerking in de zorg doorgeschoten?

In s&d 2009/4 bekritiseerden Margo Trappenburg en Martin Buijsen het nieuwe zorgstelsel: marktwerking zou ongelijkheid in de hand werken. Erik Schut betoogt het tegenovergestelde: meer doelmatigheid gaat juist samen met een grotere toegankelijkheid. Curatieve, langdurige en welzijnszorg zijn verschillend georganiseerd. Is de markt te veel ruimte gegund? ‘Die vraag is niet met een volmondig “ja” of “nee” te beantwoorden.

Workable competition in health care: Prospects for the Dutch design

__Abstract__ Since 1989 a gradual restructing of the Dutch health care system is taking place to realize a multiple choice social health insurance system with workable competition among health care providers. This paper investigates whether the structural change will induce the intended competition. An examination of the characteristics of the markets for health insurance, physician services and hospital services in the Netherlands points out that the scope for competition is limited. If competition is to work, rather extensive government regulation to monitor the conduct of both providers and insurers is needed. Without an effective antitrust policy a high degree of concentration and collusion is likely

Competition in the Dutch Health Care Sector

For more than two decades, Dutch health policy has been marked by a search for a suitable market order in health care. Suitable in the sense of maintaining universal access, containing the growth of health care expenditure and improving the technical and allocative efficiency of health care delivery. This search was spurred by the seemingly uncontrollable escalation of health care expenditure during the early 1970s. The solution initially put forward to control health care cost inflation was that of comprehensive government planning. Although the envisioned sophisticated health planning largely failed, the government did manage to gain substantial control over total health care expenditure by unilaterally imposing restrictions on the capacity and operating expenses of inpatient care institutions. However, the adverse consequences of such a top-down rationing strategy were the subject of growing criticism. Health care was thought to be too inefficient due to detailed government regulations which impeded cost-effective substitution of care (technical efficiency), provision of 'tailor-made' care to consumers (allocative efficiency) and quality-improving and cost-reducing innovations in the organization and delivery of care (dynamic efficiency). Since in many industries the market mechanism is seen as the most successful device for enhancing efficiency it is not surprising that the search continued in the direction of a more marketoriented health care system. Therefore, since the mid-1980s, competition has become the new 'buzzword' in health policy. This change of direction was in accordance with a much broader international reorientation of social policy under the banner of 'more market, less government' which is steadily undermining the Dutch corporatist welfare state. For a long time, however, competition was widely regarded as an unsuitable mechanism for determining resource allocation in health care. Competition was generally considered as having adverse effects on not only access and equity but also on efficiency, due to the presence of pervasive information problems. This raises the question of why the expectations on the role of competition in health care have changed and whether there is some reason behind this rhetoric. In this thesis the role and feasibility of competition in the Dutch market for health insurance and medical care are investigated. Competition is an elusive term, one which is used to describe either a particular market structure or a certain type of conduct. In the latter case, competition may cover all aspects of a commodity but could also be restricted to specific aspects, non-price competition for instance. In this thesis the term competition will be used to denote rivalry among sellers of a commodity for the patronage of potential buyers where rivalry concerns both price and non-price aspects of that commodity

Naar nieuwe beheersstructuren in de Nederlandse gezondheidszorg?

De economische ordening van de Nederlandse gezondheidszorg staat aan de vooravond van drastische veranderingen, waarbij prijsvorming en toetreding aanzienlijk zullen worden geliberaliseerd. Deze veranderingen nopen tot een herziening van de relaties tussen en binnen de (organisaties van) zorgvragers, zorgverzekeraars en zorgaanbieders. In dit artikel geven wij een aanzet om te komen tot een systematische indeling van mogelijke beheerstructuren voor de relaties tussen zorgverzekeraars, ziekenhuizen en medische specialisten. Doel van een dergelijke indeling is te komen tot een selectie van beheersstructuren die geschikt zijn voor de gewijzigde verantwoordelijkheidsverdeling in het nieuwe zorgstelsel

Uitkomstbekostiging in de zorg: een (on)begaanbare weg?

__Abstract__ In veel landen – waaronder Nederland – groeien de zorgkosten sterker dan de economie, schiet de kwaliteit van zorg op diverse punten tekort, en duidt praktijkvariatie op ruimte voor het verhogen van de doelmatigheid van zorg. Inadequate bekostigingssystemen en de gebrekkige transparantie van de kwaliteit van zorg worden vaak genoemd als belangrijke oorzaken van deze problemen. Zo was een belangrijke conclusie van de recente evaluatie van het zorgstelsel dat het bij zorgaanbieders vaak nog ontbreekt aan financiële prikkels voor kwaliteit en doelmatigheid

Financing long-term care: The role of culture and social norms: Comment on “Financing long-term care: Lessons from Japan”

Based on the experiences of Japan and Germany, Ikegami argues that middle-income countries should introduce public long-term care insurance (LTCi) at an early stage, before benefits have expanded as a result of ad hoc policy decisions to win popular support. The experience of the Netherlands, however, shows that an early introduction of public LTCi may not prevent, but instead even facilitate later extensions of public coverage. We argue that social norms and cultural values about caring for the elderly might be the main driver of expansions of LTCi coverage. Further

Zorgverzekeraars kampen met vertrouwensprobleem

Sinds de invoering van het nieuwe zorgstelsel in 2006 hebben verzekeraars een belangrijke rol als zorginkoper gekregen. Zij worden geacht, in naam van hun verzekerden, te onderhandelen met zorgaanbieders over de prijs en kwaliteit van de zorg. Een cruciale conditie voor verzekeraars om effectief te kunnen onderhandelen met zorgaanbieders is dat zij verzekerden naar geselecteerde zorgaanbieders kunnen sturen. Want alleen dan moet een zorgaanbieder er serieus rekening mee houden dat een verzekeraar en zijn verzekerden niet naar de concurrent overstappen (Varkevisser et al., 2006) ... etc

Displaced, disliked and misunderstood

With aging populations, the role of private insurance in financing late-in-life risks is likely to grow. Yet, demand for long-term care insurance (LTCI) and life annuities (hereafter annuities) is very limited and lags behind economic projections. This systematic literature review surveys the large number of theoretical and empirical studies analyzing this contradiction. We examine the LTCI and annuity puzzles separately and show which factors limit demand for insurance against both late-in-life risks. Our systematic search rendered 3,945 unique hits and findings of 187 studies were integrated in our analyses. Results hereof suggest that holding of both insurance products is systematically impeded by substitution by social security, adverse selection, nonstandard preferences and limited rationality due to low financial literacy and risk unawareness. Furthermore, insurance holding is concentrated among wealthier and subjectively healthier individuals. A comprehensive approach addressing all four reasons for low uptake may increase insurance holding most effectively and may particularly empower people with lower socio-economic status to make well-informed decisions

Evaluatie aanvullende en collectieve verzekeringen 2008

In dit rapport wordt verslag gedaan van een onderzoek naar de mogelijke gevolgen van aanvullende en collectieve verzekeringen voor risicoselectie en verzekerdenmobiliteit in de basisverzekering. De analyse heeft betrekking op het jaar 2008. Tevens worden de ontwikkelingen in 2008 vergeleken met de bevindingen van voorafgaande evaluatiestudies over eerdere jaren. Het onderzoek is uitgevoerd in opdracht van de Nederlandse Patiënten Consumenten Federatie (NPCF)