Ft. Schut et Eka. Van Doorslaer, Towards a reinforced agency role of health insurers in Belgium and the Netherlands, HEALTH POLI, 48(1), 1999, pp. 47-67
Citations number
40
Categorie Soggetti
Public Health & Health Care Science","Health Care Sciences & Services
This article describes some recent developments in health insurance in Belg
ium and the Netherlands. Both countries are moving towards greater financia
l responsibility of health insurers by means of risk-adjusted capitation pa
yment systems. Although for the unwary observer it would appear as if both
countries were following similar paths towards a common model, the authors
make clear that rather different underlying rationales are driving these tr
ends. In the Netherlands, the grand design 'Dekker proposal' for regulated
competition has been replaced by a more gradual implementation of reforms w
ith more limited scope. The ultimate goal remains a system of managed compe
tition, albeit only for part of the health care services. In Belgium, prosp
ective risk-adjusted capitation payment has always been at the heart of the
original system in principle since its inception, but non-enforcement led
to retrospective and inequitable financing in practice. Although the rhetor
ic of managed competition has never been used explicitly in any Belgian off
icial government policy document, it seems unlikely that putting the insure
rs at financial risk without simultaneously also reinforcing their agency r
ole by providing instruments for care management-like, for example, selecti
ve contracting-is viable in the longer run without jeopardizing the solvenc
y of the insurers. The authors conclude that although the logic of the mana
ged competition model is appealing, the lack of conclusive empirical eviden
ce of success elsewhere makes governments reluctant to surrender their trad
itional cost containment tools. But making insurers financially accountable
without simultaneously providing them with tools to take on the accountabi
lity seems useless and illogical. (C) 1999 Elsevier Science Ireland Ltd. Al
l rights reserved.