Managed competition in the Netherlands: an example for others?

Recently, we published the 2010 Health Systems in Transition review for the Netherlands.1 It is the first attempt to give a full blown description of the Dutch health system after major health reform in 2006. This reform, introduced after almost two decades of preparation, has brought important new regulatory mechanisms and structures to the Dutch health system. The reform can be seen as the realisation of a long-standing political wish to unite the old sickness fund scheme, which covered about two-thirds of the population, and the voluntary private health insurance scheme, for individuals with an income above a certain threshold. As a regulatory mechanism the reform introduced managed competition among actors in health care. Early attempts to unite all health insurance schemes into a single mandatory scheme failed at the beginning of the 1990s, mainly because of strong opposition from health insurers, employers and physicians. During the 1990s, however, smaller reforms originating from early plans were gradually implemented. This helped pave the way for the final and successful attempt at reform in 2006.