To what degree are health insurance enrollees in the Netherlands aware of the restrictive conditions attached to their policies?

Autor: van der Hulst FJP; Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, Utrecht, the Netherlands. Electronic address: f.vanderhulst@nivel.nl., Holst L; Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, Utrecht, the Netherlands., Brabers AEM; Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, Utrecht, the Netherlands., de Jong JD; Nivel, the Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN Utrecht, Utrecht, the Netherlands; Maastricht University, PO Box 616, 6200 MD Maastricht, Maastricht, the Netherlands.
Jazyk: angličtina
Zdroj: Health policy (Amsterdam, Netherlands) [Health Policy] 2022 Jul; Vol. 126 (7), pp. 693-703. Date of Electronic Publication: 2022 May 16.
DOI: 10.1016/j.healthpol.2022.05.006
Abstrakt: Background: Within the Dutch healthcare system of managed competition, health insurers can contract healthcare providers selectively. Enrollees who choose a health insurance policy with restrictive conditions will have to make a co-payment if they consult a non-contracted provider. This study aims to gain insight into enrollees' awareness of the conditions of such health insurance policies.
Methods: In August 2020, an online questionnaire was sent out via health insurers to their enrollees with restrictive health plans. In total 13,588 enrollees responded.
Results: One fifth of the respondents appeared to be totally unfamiliar with the policy conditions. Men, younger people, people with a low level of education, a lower income, a poorer health status and non-care users were found to be less familiar with the conditions. Of those who have been in the situation that they wanted to visit a healthcare provider whose care was not fully reimbursed, 62% went to that provider. Of those who had to pay extra because hospital care was not fully reimbursed, 62% did not know this in advance and 30% indicated that paying extra was a serious problem.
Conclusions: Not all enrollees who choose a policy with restrictive conditions are aware of the consequences of receiving care from non-contracted providers. Increased awareness among enrollees will benefit the functioning of the healthcare system based on managed competition.
(Copyright © 2022. Published by Elsevier B.V.)
Databáze: MEDLINE
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