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Role of supplementary health insurance in switching behaviour of consumers in the Netherlands.

Holst, L., Brabers, A.E.M., Jong, J.D. de. Role of supplementary health insurance in switching behaviour of consumers in the Netherlands. European Journal of Public Health: 2018, 28(supl. 4) 249. Abstracts: 11 th European Public Health conference: Winds of change: towards new ways of improving public health in Europe, Ljubljana, Slovenia 28 November –1 December 2018.
Background
The healthcare systems of several countries have elements of managed competition in which consumers can choose between multiple insurers. The goal of a healthcare system based on managed competition is that it maintains the quality of care while keeping it accessible for all. In order to let the principle of managed competition function properly, all consumers should have equal opportunities to switch insurer. There are indications that some consumers experience barriers to switch, which could have negative consequences for the intended goals of the system.

Aim
This study aims to explore the role of the supplementary health insurance in the switching behaviour of consumers in the Netherlands. Dutch citizens are obliged to take out a basic insurance and can opt for supplementary insurance. Due to rising costs, policy could be directed at limiting the coverage of the basic insurance causing the supplementary insurance to become more important.

Methods
Questionnaires have been sent to 1,500 members of the Dutch Health Care Consumer Panel (DHCCP) in February 2017 and 1,854 members of the National Panel of the Chronically Ill and Disabled (NPCD) in April 2017. The response rates were respectively 44% (n = 659) and 86% (n = 1,593).

Results
In the general population, 6% of the consumers with a supplementary insurance switched insurer, while 16% of the consumers without a supplementary insurance switched. Chronically ill and disabled consumers with a supplementary insurance switched less, namely 5%. Reasons why consumers do not switch are now further analyzed.

Conclusions
Preliminary results show that consumers with a supplementary insurance switch less often than consumers without a supplementary insurance. Potential reasons for this finding are that consumers with a supplementary insurance are more risk averse and rather avoid the decision to switch. This might imply that the principle of managed competition in the Dutch healthcare system does not work entirely as intended.

Key messages:
Having a supplementary insurance can hold consumers back to switch from insurer.
The supplementary insurance can have implications for how the system of managed competition works.