Skip to main content
×
×
Home

Can universal access be achieved in a voluntary private health insurance market? Dutch private insurers caught between competing logics

  • Robert A. A. Vonk (a1) (a2) and Frederik T. Schut (a3)
Abstract

For almost a century, the Netherlands was marked by a large market for voluntary private health insurance alongside state-regulated social health insurance. Throughout this period, private health insurers tried to safeguard their position within an expanding welfare state. From an institutional logics perspective, we analyze how private health insurers tried to reconcile the tension between a competitive insurance market pressuring for selective underwriting and actuarially fair premiums (the insurance logic), and an upcoming welfare state pressuring for universal access and socially fair premiums (the welfare state logic). Based on primary sources and the extant historiography, we distinguish six periods in which the balance between both logics changed significantly. We identify various strategies employed by private insurers to reconcile the competing logics. Some of these were temporarily successful, but required measures that were incompatible with the idea of free entrepreneurship and consumer choice. We conclude that universal access can only be achieved in a competitive individual private health insurance market if this market is effectively regulated and mandatory cross-subsidies are effectively enforced. The Dutch case demonstrates that achieving universal access in a competitive private health insurance market is institutionally complex and requires broad political and societal support.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Can universal access be achieved in a voluntary private health insurance market? Dutch private insurers caught between competing logics
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Can universal access be achieved in a voluntary private health insurance market? Dutch private insurers caught between competing logics
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Can universal access be achieved in a voluntary private health insurance market? Dutch private insurers caught between competing logics
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
*Correspondence to: Robert A. A. Vonk, Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands. Email: r.vonk@maastrichtuniversity.nl
References
Hide All
Baldwin, P. (1990), The Politics of Social Solidarity: Class Bases of the European Welfare State, 1875-1975, Cambridge, England and New York: Cambridge University Press.
Bluth, R. (2018), ‘A health plan “down payment” is one way states try retooling individual mandate’, Kaiser Health News, March 9.
Boonen, L. H. H. M. and Schut, F. T. (2011), ‘Preferred providers and the credible commitment problem in health insurance: first experiences with the implementation of managed competition in the Dutch health care system’, Health Economics, Policy and Law, 6(2): 219235.
Buchner, F. and Wasem, J. (2006), ‘“Steeping” of health expenditure profiles’, The Geneva Papers on Risk and Insurance – Issues and Practice, 31(4): 581599.
Congressional Budget Office (2017), ‘Repealing the individual health insurance mandate: an updated estimate’, Publication 53330, November 8, Washington, DC: CBO.
Colombo, F. and Tapay, J. (2004), Private Health Insurance in OECD Countries: The Benefits and Costs for Individuals and Health Systems, Paris: OECD.
Companje, K. P., Hendriks, R. H. M., Veraghtert, K. F. E. and Widdershoven, B. E. M. (2009), Two Centuries of Solidarity. German, Belgian and Dutch Social Health Insurance 1770-2008, Amsterdam: Aksant.
De Wit, G. W. (1969), ‘Ziektekostenverzekering. Technische grondslagen van de Nederlandse ziektekostenverzekering (Health insurance. Technical foundations of the Netherlands health insurance)’, Het Verzekerings-Archief, 46: 141154.
Enthoven, A. C. and van de Ven, W. P. M. M. (2007), ‘Going Dutch. Managed-competition health insurance in the Netherlands’, New England Journal of Medicine, 357(24): 24212423.
Ewald, F. (1986), L’Etat Providence (The Welfare State), Paris: Grasset.
Feddersen, B. (1935), ‘Mathematische Grundlagen für die private Krankenversicherung (The Mathematical fundamentals of private health insurance)’, Neumanns Zeitschrift für Versicherungswesen, 58: 12731278.
Hacker, J. S. (2002), The Divided Welfare State: The Battle over Public and Private Social Benefits in the United States, New York: Cambridge University Press.
Handel, B. R., Kolstad, J. T. and Spinnewijn, J. (2015), ‘Information frictions and adverse selection: Policy interventions in health insurance markets’. NBER Working paper No. w21759; National Bureau of Economic Research.
Helderman, J. K., Schut, F. T., van der Grinten, T. E. and van de Ven, W. P. (2005), ‘Market-oriented health care reforms and policy learning in the Netherlands’, Journal of Health Politics, Policy and Law, 30(1–2): 189209.
Hu, A. and Manning, P. (2010), ‘The global social insurance movement since 1880s’, Journal of Global History, 5(1): 125148.
Juffermans, P. (1982), Staat en gezondheidszorg in Nederland (State and Health Care in The Netherlands), Nijmegen: SUN.
Kappelhof, A. C. M. (2004), ‘Omdat het historisch gegroeid is. De Londense commissie-Van Rhijn en de ontwikkeling van de sociale verzekering in Nederland (1937-1952) (Because it has historically developed this way. The London Van Rhijn-Committee and the development of social insurance in the Netherlands (1937-1952))’, Tijdschr voor Soc en Econ Geschied, 1(2): 7191.
KISG (1981), Jaarboek 1980 (Yearbook 1980), Bunnik: KISG.
KISG (1986), Jaarboek 1985 (Yearbook 1985), Houten: KISG.
KISG (1991), Jaarboek 1990 (Yearbook 1990), Houten: KISG.
Kunneman, H. L. (1951), De Ziektekostenverzekering (Health Insurance), Zeist: Sint Gregoriushuis.
Lengwiler, M. (2010), ‘Competing appeals: the rise of mixed welfare economics in Europe, 1850-1945’, in G. W. Clark, G. Anderson, C. Thomann and J. Matthias-Graf von der Schulenburg (eds), The Appeal of Insurance. Toronto: University of Toronto Press, 173–200.
Maarse, H., Jeurissen, P. and Ruwaard, D. (2016), ‘Results of the market-oriented reform in the Netherlands: a review’, Health Economics, Policy and Law, 11(2): 161178.
Oberlander, J. (2016), ‘Implementing the Affordable Care Act: the promise and limits of health care reform’, Journal of Health Politics, Policy and Law, 41(4): 803826.
Rothschild, M. and Stiglitz, J. (1976), ‘Equilibrium in competitive insurance markets: an essay on the economics of imperfect information’, Quarterly Journal of Economics, 90(4): 629649.
Schut, F. T. (1995), “Competition in the Dutch Health Care Sector.” Ph.D. thesis, Erasmus University, Rotterdam.
Schut, F. T. and Varkevisser, M. (2013), ‘Tackling hospital waiting times: the impact of past and current policies in the Netherlands’, Health Policy, 113(1–2): 127133.
Scott, W. R., Ruef, M., Mendel, P. and Caronna, C. (2000), Institutional Change and Health Care Organizations: From Professional Dominance to Managed Care, Chicago: University of Chicago Press.
Thornton, P. (2004), Markets From Culture: Institutional Logics and Organizational Decisions in Higher Education Publishing, Stanford: Stanford University Press.
Thornton, P. H., Ocasio, W. and Lounsbury, M. (2012), The Institutional Logics Perspective: A New Approach to Culture, Structure and Process, Oxford: Oxford University Press.
Tosberg, A. (1936), ‘Die mathematische Behandlung der privaten Krankenversicherung (The mathematical treatment of private health insurance)’, Neumanns Zeitschrift für Versicherungswesen, 59: 125128.
Van de Ven, W. P. M. M. and Schut, F. T. (2008), ‘Universal mandatory health insurance in the Netherlands: a model for the United States?’, Health Affairs, 27(3): 771781.
Van de Ven, W. P. M. M. and Schut, F. T. (2011), ‘Guaranteed access to affordable coverage in individual health insurance markets’, in S. Glied and P. C. Smith eds The Oxford Handbook of Health Economics, Oxford: Oxford University Press.
Van Zanden, J. L. (1998), The Economic History of the Netherlands 1914-1995. A Small Open Economy in the “long” Twentieth Century, London and New York: Routledge.
Vektis (2006), Zorgmonitor 2006. Financiering van de zorg in 2005 (Health care monitor. Financing health care in 2005), Zeist: Vektis.
Vonk, R. A. A. (2012), ‘Een taak voor de staat? Sociale zekerheid, de bezetting en de totstandkoming van de verplichte ziekenfondsverzekering in Nederland, 1939-1949 (Responsibility of the state?: Social security, the German occupation and the introduction of compulsory social health insurance in the Netherlands, 1939-1949)’, BMGN-Low Countries Historical Review, 127(3): 328.
Vonk, R. A. A. (2013), Recht of Schade. Een geschiedenis van particulier ziektekostenverzekeraars en hun positie in het Nederlandse zorgverzekeringsbestel, 1900-2006 (A Right or a Loss? A History of Private Health Insurers and Their Position in the Dutch Health-Insurance System, 1900-2006), Amsterdam: Amsterdam University Press.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
  • URL: /core/journals/health-economics-policy-and-law
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed