Health Economics, Policy and Law

Articles

Choice of providers and mutual healthcare purchasers: can the English National Health Service learn from the Dutch reforms?1

Gwyn Bevana1 c1 and Wynand P. M. M. van de Vena2

a1 Professor of Management Science, Department of Management, London School of Economics and Political Science, London, UK

a2 Professor of Health Insurance, Department of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands

Abstract

In the 1990s, countries experimented with two models of health care reforms based on choice of provider and insurer. The governments of the UK, Italy, Sweden and New Zealand introduced relatively quickly ‘internal market’ models into their single-payer systems, to transform hierarchies into markets by separating ‘purchasers’ from ‘providers’, and enabling ‘purchasers’ to contract selectively with competing public and private providers so that ‘money followed the patient’. This model has largely been abandoned where it has been tried. England, however, has implemented a modified ‘internal market’ model emphasising patient choice, which has so far had disappointing results. In the Netherlands, it took nearly 20 years to implement successfully the model in which enrollees choose among multiple insurers; but these insurers have so far only realised in part their potential to contract selectively with competing providers. The paper discusses the difficulties of implementing these different models and what England and the Netherlands can learn from each other. This includes exploration, as a thought experiment, of how choice of purchaser might be introduced into the English National Health Service based on lessons from the Netherlands.

Correspondence:

c1 Correspondence to: Gwyn Bevan, Professor of Management Science, Department of Management, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK. Email: R.G.Bevan@lse.ac.uk

Footnotes

1 This paper was presented at the Autumn 2009 meeting of the European Health Policy Group.