Risk adjusted premium subsidies and risk sharing: key elements of the competitive sickness fund market in the Netherlands

• Published in: Health policy (Amsterdam) Vol. 65; no. 1; pp. 49 - 62
• Main Authors: Lamers, Leida M., van Vliet, René C.J.A., van de Ven, Wynand P.M.M.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.07.2003; Elsevier
• Series: Health Policy
• Subjects: Capitation Fee; Competition; Consumer behaviour; Consumer mobility; Europe; Health; Health administration; Health Care Reform - economics; Health policy; Humans; Insurance Coverage - economics; Insurance Selection Bias; Managed Competition - economics; Models, Econometric; National Health Programs - economics; National Health Programs - organization & administration; Netherlands; Policy studies; Risk; Risk adjusted premium subsidies; Risk Adjustment - methods; Risk Management; Risk selection; Risk sharing; Risk Sharing, Financial; Sickness fund; Social Security - economics; Subsidies; Netherlands; Risk sharing; Risk selection; Risk adjusted premium subsidies; Consumer mobility; Sickness fund
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/S0168-8510(02)00116-1

As part of a market-oriented health care reform, in 1991 risk adjusted premium subsidies were introduced in the Dutch social health insurance sector. Currently the premium subsidies are primarily based on demographic variables. To mitigate the obvious inadequacy of these risk adjusters, the system of risk adjustment is supplemented with a system of risk sharing. This paper describes the main characteristics of the Dutch health care system and the development of risk adjustment and risk sharing in the last decade. The effects of introducing financial risk for Dutch sickness funds on risk selection and consumer mobility are analysed. The paper concludes with a description of expected future developments.