The introduction of the Zorgverzekeringswet (Health Insurance Act) on 1 January 2006 ushered in a new era of health insurance in the Netherlands. The old dual system of social and private health insurance was replaced by a social health insurance scheme under private law. With the reform the official ban on profit-making in health care was lifted. Opponents of this market-oriented change feared that by allowing profit, long-held principles as social solidarity, equal access to health care and ultimately the quality of care itself would be subverted.

Not surprisingly, they depicted the reform as a victory for the commercial health insurance industry and their neo-liberal political supporters. However, if we take a look at the health insurance carriers that were active in the Netherlands around the time of the reform, virtually all of them were not-for-profit entities. This suggests that, contrary to popular belief, even the alleged stronghold of commercial insurers, the private health insurance industry, was heavily influenced by not-for-profit thinking. But how did this come to be that way?

This chapter will attend that question. I will examine in what way the not-for-profit health insurance ideology, personified in sickness funds and their (social) health insurance scheme, has influenced for-profit health insurers in the Netherlands during the twentieth century. I will conclude that both the government and sickness funds, though not always intentionally and not always in a coordinated manner, have tried to either neutralize or incorporate for-profit insurers in the broader system of health care financing.