Liberalization of the health care market
Description:
Due to developments in society (ageing population, increased consumerism) and medical technology there will stay an upwards pressure to health care expenditures. Government will keep the responsibility for accessibility, quality and affordability of health care for all citizens, but it defines this role more facilitating. Liberalization means less government involvement in the health care market. In tyhe health care market one can distinguish 4 sub-markets. First, the health care procurement market in the Netherlands is defined as the market between sellers (hospitals) and buyers (mostly insurers, but in the future maybe also employer and individuals). Second, the insurance is defined as the market between insurance companies and individuals or collectives who want to buy an insurance.
Liberalization will lead to all kinds of new health organization models, like Health Maintenance Organizations (cooperation between insurance and hospital, e.g. USA), hospital-nursing homes combinations, but also listed hospitals. As from 2012 it will be possible for hospitals to make a profit.
Enablers:
o The increase of health care cost will urge the government to introduce more efficient, market oriented systems. The current Dutch government adagio is “market where possible, and only intervene when necessary
o In the current budget system all capital expenditures are separately funded and guaranteed by government. As from 2012 hospitals will be fully responsible for their income and production (WTZi).
o The new hospital financing system (DBC’s) makes differences between hospitals in price and quality visible. By that competition between hospitals will increase
Inhibitors:
o The evolution of the current parliamentary democracy. Will the Dutch parliament be able to let loose, or will it intervene as it does now. Although formally the parties have agreed upon liberalization, the first signs of second thoughts within Dutch parliament are very clear
o The convergence of European health care market systems. Will the EU formulate a policy on health care market systems? So far, the EU has only intervened in food security, labor market and border crossing health care consumption.
Paradigms:
The fundamental shift in thinking is the transformation from a regulated system, like in most other European countries to a much more market oriented system in which government has much less control and market forces will drive development.
Experts:
Ministry of health (www.minvws.nl), College Bouw (www.cbz.nl), ZAio (www.ctg-zaio.nl)
Timing:
Start new insurance system (zorgverzekeringswet) 1-1-2006
Start new hospital financing system (DBC’s) 1-1-2005, finish 1-1-2008
Start liberalization construction of hospitals (WTZi) 1-1-2006, finish 2012