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Results of the market-oriented reform in the Netherlands: a review

  • Hans Maarse (a1), Patrick Jeurissen (a2) and Dirk Ruwaard (a1)

The market-oriented reform in the Dutch health care system is now in its 10th year. This article offers a concise overview of some of its effects thus far on health insurance, healthcare purchasing and healthcare provision. Furthermore, attention is given to its impact on healthcare expenditures, power and trust relationships as well as the relationship between the Minister of Health and the Dutch Healthcare Authority. The reform triggered various alterations in Dutch health care some occurring quickly (e.g. health insurance), others taking longer (e.g. purchasing). These developments suggest a process of gradual transformation. The reform has instigated controversy which is increasingly framed as a power conflict between insurers and providers. Weakened consumer trust in insurers threatens the legitimacy of the reform. The relationship between Minister and Healthcare Authority appears to be more intimate than the formal independent status of this regulatory agency would suggest.

Corresponding author
*Correspondence to: Professor Hans Maarse, Maastricht University, Department of Health Services Research, Maastricht. Email:
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Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
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