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The introduction of managed competition in the Dutch healthcare system along with public reporting of quality information is associated with performance improvement in health plans, according to a study published in the open access journal BMC Health Services Research.
Dutch health plans have improved their service over the years. Requirements for (co)payment are clearer, the conduct of employees has improved and information is easier to find and understand. Enrolees rate health plans more positive than before. These results are based on comparisons of health-plan performance over the past four years. NIVEL and the Dutch Centre for Consumer Experience in Health Care measured the experiences of consumers with their health plan annually from 2005 to 2008 using the CQI® health plan instrument. Remarkably, the differences between health plans became smaller over the years. The performance of health plans that scored below average in 2005 increased more than the performance of health plans that scored average and/or above average in that year.
Fear for reputation damage
NIVEL-researcher Michelle Hendriks: “About 3-4% of the Dutch population switches health plan each year. The improvement in performance can, therefore, not be explained by people massively switching health plans. But public reporting of comparative quality information on the Internet along with the introduction of managed competition in the Dutch healthcare system appear to instigate health plans to improve their service. Three possible motives for health plans are the fear to loose market share, reputation protection and an intrinsic motivation to perform well. Which motive is most important, is unknown. It seems plausible that fear for reputation damage and for loosing clients are both important.”
Inferior access of call centre
The performance of health plans has improved but not on all aspects. Unfortunately, areas of improvement that existed in the former healthcare system still persist. The access of the call centre has not improved. Uncertainty about (co)payment requirements diminished but did not disappear. People choosing a health plan should take these aspects into account. For health plans, it provides an opportunity to excel in certain areas.
Consumer Quality Index (CQ-index or CQI) instruments assess the quality of health care seen from the consumer’s perspective. Several CQI instruments have been or are being developed. The method of the CQ-index was introduced in the Netherlands by NIVEL, in cooperation with the Department of Social Medicine of the Academic Medical Centre of the University of Amsterdam. The implementation was financed by health insurer Agis, Miletus (a cooperation of health insurers) and ZonMw (Netherlands organisation for health research and development). The Dutch Centre for Consumer Experience in Health Care is responsible for the development, implementation and protection of the trademark CQ-index.