The effects of competition-oriented health reforms on the Netherlands health care system and on the relations between general practitioners, statutory insurance bodies and insured patients

The German health care policy debate is affected by proposals demanding the introduction of competitive elements. Analysis of the effects of regulated competition in the Netherlands health care system shows that actual behavi oural changes of the key actors of the system differ considerably from expe cted changes, although incentives within the system have been substantially changed. Sickness funds are not selectively linked with providers and insu red patients do not change their insurance company very often. From the poi nt of view of the original reform targets, this preliminary result is quite disappointing. It can be explained by the fact that the relations between sickness funds, general practitioners and insured persons or patients are w ithin a broader framework Of health care. Thus, competition does not seem a ttractive to either of them. If regulated competition became more dominant, several undesirable effects on the so far well-appreciated primary care ma y be expected.