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Consumer mobility in the Dutch health insurance system: the role of collectives.

Brabers, A.E.M., Reitsma-van Rooijen, M., Jong, J.D. de. Consumer mobility in the Dutch health insurance system: the role of collectives. European Journal of Public Health: 2012, 22(suppl. 2) 264-265. Abstract. 5th European Public Health Conference 'All inclusive public health'. 7-10 November 2012, St. Julians (Malta).
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Background: In the last decades, health care reforms based on introducing managed competition have been implemented in several countries. The policy assumption is that managed competition leads to lower prices and increases the quality of health care. In The Netherlands the system of managed competition was introduced in 2006. Consumer mobility is an important element. Every year, during an annual enrolment period, consumers who are not satisfied with the premium or quality of care can switch insurer. This should force insurers to strive for a good balance between price and quality. The premium is the most important reason for individuals to switch. This might result in price competition only, instead of also having competition based on quality of care. Quality improvements can potentially be achieved by collectives. In contrast to individuals, collectives can negotiate with insures on both price and quality of care. Because of the threat of losing a large number of insured, collectives might exert more influence on insurers than individuals. On the other hand collectives might also decrease consumer mobility. The aim of this study was to assess the role of collective contracts in relation to consumer mobility. Methods: Questionnaires have been sent to members of the Dutch Health Care Consumer Panel. Data are available for the years 2006 to 2009, 2011 and 2012. The response rates on the questionnaires range from 58% to 81%. Among others, questions were aimed at measuring the number of collectively insured and whether joining a collective is a switching reason. Results: A high number of individuals are insured via collective contracts; ranging from 55% of all those insured during 2006, increasing to 70% in 2012. The percentage of switchers that indicate the wish to join a collective contract with another insurer as switching reason differs over years. In 2012 20% of the switchers indicated this, compared to 6% in 2011, 22% in 2009, 11% in 2008, 37% in 2007 and 57% in 2006. The data are now further analysed. Conclusion: Preliminary results show that the number of people collectively insured has increased. It appears that collectives do not hamper consumer mobility, since there is a periodic increase in the number of switchers due to the wish of joining a collective. (aut. ref.)
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