Money rather than quality impetus to competition

In 2011 8% of the Dutch population switched health care insurer. This is the highest rate ever since in 2006 the Health Insurance Act was introduced and 20% of the population changed health care insurer. Especially young people change. Premium is by far the most important reason to change. In the new health care system money rather than quality appears to be the impetus to competition. This is the result of a study regarding the motives for changing health care insurer, published in Eurohealth by NIVEL researchers.

After the introduction of the Health Insurance Act in 2006, 20% of the population changed health care insurer. The years after 2006, the number of insured people who changed insurer went down to 6% in 2007, to 4% in 2008 and to 3% in 2009. In 2011 8% changed health care insurance, as figures of NIVEL’s Dutch Health Care Consumer Panel show. Young people are still the main group that changes insurer. In the age group 18 to 40 years, 12% changed. Of the people between 40 and 65 years 6% changed and of the 65+ 2.0%.

By far the main reason to change turns out to be the premium: 52% of the switchers mention the premium as reason to change and that is substantially more than in previous years. NIVEL programme coordinator Judith de Jong: “In 2011 the average yearly premium of the basic insurance rose with 9.1% to 1,256 Euros. This is the highest premium increase since the introduction of the new insurance system in 2006. Additionally, the premium differences between health care insurers are large. The difference between the cheapest and most expensive basic insurance is 276 Euros per year – worthwhile to change.”

Quality of care
Quality turns out to be hardly a reason to change. Less than 1% changed because of the quality of care. De Jong: “This is remarkable, because the introduction of the new health insurance system was explicitly meant to make sure people would choose a health care insurer because of the premium as well as the quality of care, contracted by the insurer. In the current system, competition in the amount of own premium turns out to be the main impetus so far.”

Satisfied or scared
Those who stay with their insurer do not change mainly because they are happy with the insurance coverage. One out of five did not change, but had considered to change. They do not see many differences between health care insurers. It is striking that this group more often mentions barriers that stop them from changing, for example fear not to be accepted or fear for administrative problems.

Dutch Health Care Consumer Panel
For this study 2000 questionnaires were sent to members of NIVEL’s Dutch Health Care Consumer Panel, 1250 of which were filled in and returned. The panel collects information from the general population in the Netherlands, about opinions on health care and experiences with health care. The panel consists of around 6000 people aged 18 years and older.

- Ministry of Health