Publicatie datum

Exit and voice in dutch social health insurance.

Gress, S., Delnoij, D., Groenewegen, P.P. Exit and voice in dutch social health insurance. CESifo DICE Report: Journal for Institutional Comparisons: 2003, 1(3), 47-53
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According to Hirschmann's concept of exit and voice, people have two options to make sure that firms or organisations realise what they (their consumers or members) are interested in (Hirschmann 1970). In the Dutch public health insurance system voice existed for a long time, but exit was only introduced in the 1990s. In this paper the authors examine the introduciton of exit in the Dutch health insurance system and discuss the combination of exit and voice. Until the early 1990-s consumers in Dutch compulsory social health insurance did not have the exit option. There was no consumer choice between sickness funds. However, sickness funds were the focal point of Dutch health system reforms in the early 1990s. Giving the insured free choice between sickness funds was supposed to bring about competition that would at the same time favour quality through selective contracting by sickness funds and curb costs through incentives for efficiency (Gress 2002). The possibility to use voice - for example, through the 'Council of Insured" or by filing a complaint - remained unchanged throughout the reforms. (aut.ref.)