Atie Schipaanboord, Diana Delnoij and Roland Bal INTRODUCTION Regulated competition was introduced into the Dutch health care system in 2006. Although this was regarded as a radical break with the past, some elements of the reform, such as competition between social health insurers, had been implemented from the 1990s onwards (Helderman et al. 2005). What was new was the introduction of an obligatory basic package of health insurance for all citizens, with health insurers obliged to accept all enrolees and compensated for ‘bad risks’ through a risk equalization fund and introduction of competition between health care providers over price and quality.1 Increased transparency of costs and quality were also part of the shift, with the introduction of a diagnosis-related group system for financing health care and the publication of performance indicators measuring quality. As a result of these changes, government involvement in the health care sector was minimized and replaced by additional audit procedures. The ‘triangle’ of insurers, providers and patients became the main regulating and coordinating mechanism in three interdependent markets, namely the health insurance market, in which health care users have a free choice of health plans and insurance companies; the provider market, where health care users can choose between providers, such as hospitals, nursing homes, and family practices; and the health care purchasing market, where health insurance companies contract health care providers (see Figure 8.1). Voice and Choice in Health Care As patients have traditionally been a weak force in the health care sector much effort has...
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