Independent Research and Policy Advocacy

Care through competition: The case of the Netherlands

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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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  1. This made interesting and informative reading. Thank you. Inevitably, the mind ran a comparison with the Indian context even while the note managed to clearly convey how complex this whole thing is (health care!). Plenty of things to learn and seek to adapt to our circumstances. our health infra, information infrastructure, dispersed low-density population pocket etc plus lack of citizen friendly information communication on insurance policies. Frankly, the standard insurance policy document I’ve received in the normal course seems designed to make a person ill! I’m fairly sure, that institutions like yours are on top of all this and working to move things along in India with good researched basis – like this paper.

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