Effects of the reform of the Dutch healthcare into managed competition: Results of a Delphi study among experts.

Autor: de Vries H; Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands. Electronic address: hein.devries@maastrichtuniversity.nl., Vahl J; Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands., Muris J; Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands., Evers S; Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands., van der Horst H; Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Free University Amsterdam, the Netherlands., Cheung KL; Health Behaviour Change Research Group, Department of Health Sciences, College of Health and Life Sciences, Brunel University London, United Kingdom.
Jazyk: angličtina
Zdroj: Health policy (Amsterdam, Netherlands) [Health Policy] 2021 Jan; Vol. 125 (1), pp. 27-33. Date of Electronic Publication: 2020 Nov 07.
DOI: 10.1016/j.healthpol.2020.10.010
Abstrakt: Background: In 2006 a major healthcare reform was introduced in the Netherlands, implying managed competition. This study explored the level of consensus on the outcomes and desired changes of this new system, and differences between stakeholder groups.
Methods: A three-round Delphi-study was conducted among Dutch healthcare insurers, health economists, and professionals in general practice (GP) care and mental health (MH) care. In the first round, 20 experts indicated the most important advantages and disadvantages of the Dutch managed competition, and desired changes. Experts in the second (n = 106) and third round (N = 88) rated the importance of the 88 factors identified in the first round.
Results: Only healthcare insurers reached consensus on important advantages (i.e. improved efficiency; room for choice). Health economists reached almost no consensus on any factors. GP and MH-care professionals reached most consensus on disadvantages (i.e. focus on price over quality, increased bureaucracy) and desired changes (i.e. reduce bargaining power of healthcare insurers; increase attention for care of complex patients); half of them suggested abolishment of managed competition.
Conclusion: GP and MH-care professionals were most dissatisfied and suggested several changes or even abolishment of the 2006 reform; healthcare insurers mentioned some benefits. This level of dissatisfaction among health care professionals indicates that there is room for improvement, preferably developed in conjunction with stakeholders.
Competing Interests: Declaration of Competing Interest The authors report no declarations of interest.
(Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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