artikel van de ven Flashcards
Why does competition in healthcare has to be regulated ?
to achieve society’s goals of efficiency and afford- ability.
it is interesting to know to what extent in these countries the necessary preconditions are fulfilled for the market to produce efficient and affordable care.
What was the conclusion in the article van de ven
Implementing regulated competition in healthcare is complex, given the pre- conditions that have to be fulfilled.
not all preconditions can be fulfilled simultaneously, tradeoffs have to be made with implications for the levels of efficiency and affordability that can be achieved.
the optimal set of preconditions is not only an empirical question but ultimately also a matter of societal preferences.
What do they mean with the efficiency and affordability in the article of van de ven
efficiency goal : relates to technical and allocative efficiency of the provision of care covered by the basic package as well as to its dynamic efficiency and to the efficiency of the provision of basic insurance.
affordability : everyone has access to affordable health insurance covering a basic care package of services of acceptable quality within reasonable travel time and without undue waiting time. So our definition of affordability includes accessibility
What is the aim of the paper of van de ven ?
identify the most important preconditions for achieving efficiency and affordability under regulated competition in healthcare
to indicate to what extent these preconditions are fulfilled in the above mentioned five countries.
Which precondition did they look at
- Free consumer choice of insurer
- Consumer information and market transparency
- Risk-bearing buyers and sellers
- Contestable markets
- Freedom to contract and integrate
- Effective competition regulation
- Cross-subsidies without incentives for risk selection
- Cross-subsidies without opportunities for free riding 9. Effective quality supervision
- Guaranteed access to basic care.
Is the condition free consumer choice of insurer satistief in the netherlands.
The Netherlands have individual health insurance.
So a family of five can in principle buy their basic health insurance from 5 different insurers.
In the Netherlands (except for HMOs) the basic benefits package is fixed.
Insurers in the Netherlands are free (and have more freedom than in the other countries) to offer the consumers a large variety of different insurance products.
Is is easy to switch for insurers in the netherlands?
The Netherlands is the only country where consumers can switch insurer without a term of notice in case of not renewing the contract.
Consumer information and market transparency
In the Netherlands there are private websites that provide comparable information about insurance products.
a government sponsored and controlled website with information about health insurance products and providers of care (www.kiesbeter.nl)
In the Netherlands the public information on the quality of care is also improving, although there is still a lack of detailed timely accessible comparative information on the quality of care,
There is good publicly-available information about the waiting times of hospitals, per specialist department.
Is the condition Risk bearing buyers and sellers satisfied
If consumers in the Netherlands switch to a more expensive insurer or insurance product their additional after-subsidy out-of-pocket premium reflects the additional costs of the new insurer or new insurance product.
The consumers’ out-of-pocket payments are the least in the Netherlands, where the mandatory deductible does not hold for general practitioners’ services and maternity care
Contestable markets
legal barriers for insurers to enter the market of basic health insurance (In all countries the legal ban on risk rating, in combination with insufficient risk equalization for the high-risk individuals, may restrict the entry to the market for insurers specialized in good quality care for the high-risk individuals.
In the Netherlands any insurer from any EU country is allowed to sell basic health insurance.
In the Netherlands the contestability of the markets for free-standing healthcare professionals has substantially increased since 2006.
In addition the Dutch government has decided to abolish the numerus clausus for medical first-year students in 2012.
Precondition 5. Freedom to contract and integrate
In the Netherlands from 2006 insurers and providers are allowed to contract selectively and to vertically integrate. Individual insurers and individual care providers gradually got more freedom to negotiate about prices, service and quality of care. In 2012 this holds to a large extent for pri- mary care, integrated care for several chronic conditions, for prescription drugs, pharmacists and dentists.
Precondition6.Effectivecompetitionregulation
In the Netherlands there is an effective competition policy to prevent anticompetitive mergers and cartels, and to prevent abuse of dominant positions in the market for basic health insurance.
Precondition 7. Cross-subsidies without incentives for risk selection
There are income-related subsidies for low-income people in the Netherlands,
In the Netherlands and the unaffordability of basic care is not an issue of public debate, which may be an indication that healthcare is not unaffordable.
Cross subsidies without opportunities for free riding
In the Netherlands there is a substantial direct out-of-pocket pre- mium to the insurer.
If uninsured people in the Netherlands join the insurance system later on, they have to pay all missing contributions from the time onwards they should have had insurance plus a late payment fine
In the Netherlands legislation has been changed in 2011 to actively enforce enrollment in an insurance contract and payment of the premium if people are not voluntarily doing so.
Effective quality supervision
In the Netherlands the Dutch Healthcare Inspectorate is developing performance indicators and enforcing the publication of a standard set of (hospital) performance indicators.
