An assessment of the Dutch experience with health insurers acting as healthcare advisors

Abstract

IntroductionWith managed competition, selective contracting and the appointing of preferred providers are important instruments for health insurers to improve their bargaining position in the healthcare purchasing market. Insurers can offer enrollees extra services, such as advice about their healthcare, to attract them, ensure that they remain loyal, and to channel them to preferred providers. We investigate which advice services insurers in the Dutch system of managed competition offer enrollees, how they inform them about services, and if enrollees use and appreciate them.Materials and methodsFrom November to December 2017, two researchers independently analyzed the websites of all health insurers in the Netherlands. We also conducted a questionnaire study among 1,500 members (response 44.5%, N = 668) of the Nivel Dutch Health Care Consumer Panel.Results and discussionAll insurers offer one or more services. Most enrollees do not know if their insurer offers advice (67–87% per service). Twelve per cent (N = 76) of the enrollees indicate that they ever made use of a service, mostly regarding the choice of provider (N = 42). Respondents who used healthcare advice were satisfied with it. Of all enrollees, 41% indicate that they would probably/certainly, contact their insurer for advice and 37% would appreciate it if their insurer approached them. Among enrollees, 40% indicated the potential advice has some or a major influence on their choice of insurer.ConclusionsWhile all insurers offer at least one service, enrollees generally are unaware of them. Only a minority ever made use of such a service. However, a reasonable proportion do appreciate their insurers’ advice services and indicate that they would like to have contact with their insurer if they need care. Insurers do not appear to make the best use of the potential for giving healthcare advice and need to think about ways to increase coverage of those services.

The relation between trust and the willingness of enrollees to receive healthcare advice from their health insurer

“…The healthcare systems of several countries, such as the Netherlands, Switzerland, Israel and Germany, are based on the theory of managed competition [ 1 – 3 ]. This theory aims to improve the quality of care and contain increasing healthcare costs by stimulating competition between third-party purchasers and care providers [ 1 , 4 – 6 ]. In such a healthcare system third-party purchasers, mostly health insurers, purchase care on behalf of their enrollees [ 5 ].…”

“…Enrollees have the option to switch health insurers. As a result, health insurers have an interest in offering enrollees a more attractive health plan than competitors [1,[5][6][7]. Therefore insurers negotiate with healthcare providers on price and quality of care.…”

How is enrollees’ trust in health insurers associated with choosing health insurance?

“…In recent decades several countries such as the Netherlands, Germany, and Switzerland, have switched to a healthcare system based on managed competition [1][2][3]. This is a system regulated by the government that stimulates competition between third party purchasers, which in most cases are health insurers, and healthcare providers [1,2,4,5]. Health insurers play an important role in such a healthcare system.…”

“…Health insurers play an important role in such a healthcare system. They are intended to behave as the prudent buyers of care on behalf of their enrollees [1,4,5]. The possibility that enrollees may switch to a competitor is supposed to be a key element in creating competition between health insurers.…”

“…Since enrollees are able to switch health insurers every year, this should give health insurers the incentive to keep enrollees satisfied by offering the most attractive health insurance package. This may include favourable conditions and prices to attract new enrollees and retain affiliated ones [1,[4][5][6]. During the purchasing negotiations with healthcare providers, according to the theory, health insurers, therefore, aim to improve the quality of care and reduce prices [5][6][7].…”