Market-Oriented Health Care Reforms and Policy Learning in the Netherlands

Abstract

In this article we analyze the evolution of market-oriented health care reforms in the Netherlands. We argue that these reforms can be characterized as policy learning within and between competing policy programs. Policy learning denotes the process by which policy makers and stakeholders deliberately adjust the goals, rules, and techniques of a given policy in response to past experiences and new information. We discern three distinctive periods. During the first period (1988-1994), the prevailing corporatist and etatist policy programs were seriously challenged by the proponents of a new market-oriented program. But when it came to political decision making and implementation, the market-oriented program soon lost its impetus because it was technically too complex and could not provide short-term solutions to meet the urgent need for cost containment. During the second period (1994-2000), the etatist program regained its previously dominant position. In parallel to a strengthening of supply and price controls, however, the government also persevered in creating the technical and institutional preconditions for regulated competition. Moreover, public discontent over waiting lists and the call for more autonomy by individual providers and insurers strengthened the alliance in favor of regulated competition. This led to the revival of the market-oriented program in a 2001 reform plan. We conclude that the odds of these new post-2001 reforms succeeding are substantially higher than in the first period due to the technical and institutional adjustments that have taken place in the past decade.

Changing choices in health care: implications for equity, efficiency and cost

“…By the late 1980s, the United Kingdom and the Netherlands were looking for ways to improve the efficiency of their systems of health care. Each sought to introduce competition, based on the ideas of Alain Enthoven (1978Enthoven ( , 1980Enthoven ( and 1985, between providers in an internal market in the United Kingdom (Bevan and Robinson, 2005) and between sickness funds in the Netherlands (Helderman et al, 2005). The idea of an internal market was widely copied in other countries.…”

Spending on Health Care in the Netherlands: Not Going So Dutch

“…Three quarters of medical specialists are organised in partnerships, which are usually specific to a hospital and a specialty (Helderman et al, 2005).…”

“…GPs act as gatekeepers for all secondary and tertiary care financed through social health insurance (Helderman et al, 2005). For care covered through social long-term care insurance, access is determined by independent assessors, with eligibility dependent upon the health status and disability of the applicant (Staatscourant, 2014).…”

The Changing Role of the State in the Dutch Healthcare System

“…In order to pacify this 'atypical' coalition Prime Minister Kok announced to abstain from any irreversible structural reform. Although this policy confirmed the compound structure of the second compartment, it left some space for incremental adjustments (Okma 2009;Helderman et al 2005). As WTZ prevented access barriers on the basis of risk profiles but not on the basis of income, the flatrate premiums became a high financial burden especially for elderly with small pensions.…”

“…-19 -tives were again rather perverse as especially hospitals with long waiting lists were financially rewarded (Helderman et al 2005). It was only intended as interim solution for the major shift towards more market competition in the contract relation.…”