Publicatie datum

Selective contracting and channelling patients to preferred providers.

Bes, R., Curfs, E., Groenewegen, P., Jong, J. de. Selective contracting and channelling patients to preferred providers. European Journal of Public Health: 2014, 24(suppl. 2), p. 22-23. Abstract: 7th European Public Health Conference 'Mind the Gap: Reducing Inequalities in health and health care'. 19-22 November 2014, Glasgow.
Background: In 2006, the Dutch health care system changed from a supplyoriented system to a demand-oriented system based on managed competition. In a system of managed competition,
health insurers (HIs) are supposed to be prudent purchasers of health care on behalf of their enrolees. In order for HIs to have a strong bargaining position in negotiations with care providers,
they need to be able to channel their enrolees to preferred care providers. Examples of ways to channel enrolees include selective contracting of care providers and giving enrolees advice on provider choice. The questions answered in this presentation are 1) What is known about the circumstances under which HIs can channel their enrolees to preferred care providers? and 2) How would enrolees in the Netherlands feel about their HI influencing their care provider choice?
Methods: To answer the first research question, a scoping review was conducted. For the second research question, a questionnaire was sent to 3430 members of the Insurance panel (response
78%) in 2011. Questions concerned respondents’ opinions about the role of the health insurer in provider choice by 22 European Journal of Public Health, Vol. 24, Supplement 2, 2014 means of selective contracting and advice. In addition, respondents who had used care in the past year were asked about their HI’s role in their choice of provider. Results: Few studies were found on how to channel patients to preferred providers. The most effective way seems to be by implementing co-payments, but enrolees are very negative about this. In the Netherlands, HIs are reluctant to implement selective contracting, because they fear their enrolees will not accept it. Results of the survey show that 60% of enrolees agree with their HI playing a role in provider choice. However, respondents who do not agree with this value their freedom of choice highly and do not trust their HI to purchase good quality care on their behalf. Conclusion: There is still a lack of knowledge on how selective contracting can be implemented in a way that enrolees will accept it. In the Netherlands, HIs seem to suffer a lack of trust from their enrolees. This presentation fits the scope of the workshop, since it describes the influence of health insurers on enrolees’ provider
choice in the context of the Dutch health care system.