The Netherlands has managed to achieve rather remarkable outcomes in terms of health, financial protection and customer satisfaction through a private-first health system, an architecture reinforced by its landmark Health Insurance Act of 2006. 16 years into the reform, this paper looks at what factors led to the transition to managed competition and to what extent the Dutch system stays true to Enthoven’s theoretical principles of managed competition. We find that while there are deviations from the theoretical model in how managed competition has been adopted, the Netherlands arguably offers one of the best models of managed competition in practice. We also find the managed competition model has been relying heavily on regulation and less on competition to work. Any attempt to adopt the Dutch model of managed competition would then depend on how capable the sponsor/ regulator is in the country or region of adoption.
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