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This study examines whether a series of unemployment insurance benefit reforms that took place over a 20-year period in the Netherlands had a gendered effect on the duration of unemployment and labor market outcomes. Using longitudinal data from the Dutch Labor Supply Panel (OSA) over the period 1980-2000, and adopting a quasi-experimental design, we test whether seemingly "gender neutral" institutional reforms result in a structural disadvantage for women in particular. Our results demonstrate a striking gender similarity in terms of shorter unemployment durations and ultimately less favorable labor market outcomes (lower occupational class, lower wage, part-time and temporary contracts) among both men and women affected by these reforms. Findings also indicate that disadvantaged groups (older and low-skilled female workers) are the most likely to experience a negative effect from state interventions. These findings provide support for the long-term gains of unemployment benefits and their role in operating as "bridges" to better employment.

This article argues that unemployment benefits are providing a crucial but often overlooked function by reducing the insecurity associated with modern labor markets. Because job insecurity is associated with concerns about future financial security, economic support during unemployment may lessen the negative effects of job insecurity on employed individuals' well-being. Using data from the European Social Survey, this article shows that the generosity of unemployment benefits makes a difference to the subjective well-being of employed individuals, especially those with limited economic resources and an insecure position in the labor market. These results indicate that unemployment benefits may be viewed as a collective resource with important external benefits, i.e., benefits to society over and above those to the unemployed who directly utilize such benefits. (Contains 3 tables, 1 figure, and 9 notes.)

Randomized response (RR) is a well-known method for measuring sensitive behavior. Yet this method is not often applied because: (i) of its lower efficiency and the resulting need for larger sample sizes which make applications of RR costly; (ii) despite its privacy-protection mechanism the RR design may not be followed by every respondent; and (iii) the incorrect belief that RR yields estimates only of aggregate-level behavior but that these estimates cannot be linked to individual-level covariates. This paper addresses the efficiency problem by applying item randomized-response (IRR) models for the analysis of multivariate RR data. In these models, a person parameter is estimated based on multiple measures of a sensitive behavior under study which allow for more powerful analyses of individual differences than available from univariate RR data. Response behavior that does not follow the RR design is approached by introducing mixture components in the IRR models with one component consisting of respondents who answer truthfully and another component consisting of respondents who do not provide truthful responses. An analysis of data from two large-scale Dutch surveys conducted among recipients of invalidity insurance benefits shows that the willingness of a respondent to answer truthfully is related to the educational level of the respondents and the perceived clarity of the instructions. A person is more willing to comply when the expected benefits of noncompliance are minor and social control is strong.

We empirically test an integral model for healthcare and child support benefits take-up using a probability sample of the Dutch population (N = 905). To examine how different psychological factors, in conjunction, explain take-up, we apply model averaging with Akaike's Information Criterion (AICC). For both types of benefits, people's perceptions of eligibility best explain take-up. For healthcare benefits, take-up also relates to perceptions of need. Exploratory analyses suggest that for healthcare benefits but not for child support benefits, executive functions, self-efficacy, fear of reclaims, financial stress, and welfare stigma explain perceived eligibility. We find no support for knowledge, support, and administrative burden as explanatory factors in take-up. We discuss the results in relation to the Capability Opportunity Motivation Behaviour (COM-B) model for developing behavioural change interventions. [ABSTRACT FROM AUTHOR]

Background: In insurance-based healthcare systems, healthcare insurers are interested in engaging citizens in care procurement to contract healthcare services that matter to people. In the Netherlands, an amendment to the Health Insurance Act was set forth in 2021 to formalize and strengthen the engagement of the insured population with healthcare insurers' procurement cycles. This study explores the role of Dutch healthcare insurers in operationalizing citizen engagement in procurement cycles before changes occur linked to the amendment to the Health Insurance Act. Methods: A phenomenological qualitative design was employed in two phases: (1) we consulted academics and policy experts on the role of healthcare insurers regarding citizen engagement; (2) we conducted focus groups with representatives of healthcare insurers to understand how citizens' engagement is being operationalized. Transcripts of the interviews with experts and detailed notes of focus group meetings were analysed using a qualitative inductive approach. Selected excerpts were analysed on discourse and content and organized by a coding scheme following a rigorous and accelerated data reduction technique. Results: We identified four strategies used by healthcare insurers to operationalize citizen engagement: (1) broadening their population health orientation; (2) developing and improving mechanisms for engaging citizens; (3) strengthening features of data governance for effective use of value-driven data; (4) implementing financial and incentive mechanisms among healthcare providers in support of value-based healthcare. However, regulated market mechanisms and low institutional trust in healthcare insurers undermine their transition from merely funding healthcare towards becoming people-centred value-based healthcare purchasers. Conclusion: Dutch healthcare insurers seem to be strengthening the community orientation of their functioning while enhancing the end-to-end experience of the insured. The expected practical effects of the amendment to the Health Insurance Act include broadening the role of the council of insurees in decision-making processes and systematically documenting the efforts set forth by healthcare insurers in engaging citizens. Further research is needed to better understand how the regulated competitive market could be hampering the engagement of citizens in healthcare procurement decision-making and value creation from the citizens' perspective. [ABSTRACT FROM AUTHOR]

Background: Oral health, coupled with rising awareness on the impact that limited dental care coverage has on oral health and general health and well-being, has received increased attention over the past few years. The purpose of the study was to compare the statutory coverage and access to dental care for adult services in 11 European countries using a vignette approach. Methods: We used three patient vignettes to highlight the differences of the dimensions of coverage and access to dental care (coverage, cost-sharing and accessibility). The three vignettes describe typical care pathways for patients with the most common oral health conditions (caries, periodontal disease, edentulism). The vignettes were completed by health services researchers knowledgeable on dental care, dentists, or teams consisting of a health systems expert working together with dental specialists. Results: Completed vignettes were received from 11 countries: Bulgaria, Estonia, France, Germany, Republic of Ireland (Ireland), Lithuania, the Netherlands, Poland, Portugal, Slovakia and Sweden. While emergency dental care, tooth extraction and restorative care for acute pain due to carious lesions are covered in most responding countries, root canal treatment, periodontal care and prosthetic restoration often require cost-sharing or are entirely excluded from the benefit basket. Regular dental visits are also limited to one visit per year in many countries. Beyond financial barriers due to out-of-pocket payments, patients may experience very different physical barriers to accessing dental care. The limited availability of contracted dentists (especially in rural areas) and the unequal distribution and lack of specialised dentists are major access barriers to public dental care. Conclusions: According to the results, statutory coverage of dental care varies across European countries, while access barriers are largely similar. Many dental services require substantial cost-sharing in most countries, leading to high out-of-pocket spending. Socioeconomic status is thus a main determinant for access to dental care, but other factors such as geography, age and comorbidities can also inhibit access and affect outcomes. Moreover, coverage in most oral health systems is targeted at treatment and less at preventative oral health care. [ABSTRACT FROM AUTHOR]

A mental healthcare system in which the scarce resources are equitably and efficiently allocated, benefits from a predictive model about expected service use. The skewness in service use is a challenge for such models. In this study, we applied a machine learning approach to forecast expected service use, as a starting point for agreements between financiers and suppliers of mental healthcare. This study used administrative data from a large mental healthcare organization in the Netherlands. A training set was selected using records from 2017 (N = 10,911), and a test set was selected using records from 2018 (N = 10,201). A baseline model and three random forest models were created from different types of input data to predict (the remainder of) numeric individual treatment hours. A visual analysis was performed on the individual predictions. Patients consumed 62 h of mental healthcare on average in 2018. The model that best predicted service use had a mean error of 21 min at the insurance group level and an average absolute error of 28 h at the patient level. There was a systematic under prediction of service use for high service use patients. The application of machine learning techniques on mental healthcare data is useful for predicting expected service on group level. The results indicate that these models could support financiers and suppliers of healthcare in the planning and allocation of resources. Nevertheless, uncertainty in the prediction of high-cost patients remains a challenge. [ABSTRACT FROM AUTHOR]

Purpose: Flood damage to uninsured single-family homes shifts the entire burden of costly repairs onto the homeowner. Homeowners in the United States and in much of Europe can purchase flood insurance. The Netherlands and Asian countries generally do not offer flood insurance protection to homeowners. Uninsured households incur the entire cost of repairing/replacing properties damaged due to flooding. Homeowners' policies do not cover damage caused by flooding. The paper examines the link between personal bankruptcy and the severity of flooding events, property prices and financial condition levels. Design/methodology/approach: A fully modified ordinary least squares (FMOLS) regression model is developed which uses personal bankruptcy filings as its dependent variable during the years 2000 through 2018. This time-series model considers the association between personal bankruptcy court filings and costly, widespread flooding events. Independent variables were selected that potentially act as mitigating factors reducing bankruptcy filings. Findings: The FMOLS regression results found a significant, positive association between flooding events and the total number of personal bankruptcy filings. Higher flooding costs were associated with higher bankruptcy filings. The Home Price Index is inversely related to the bankruptcy dependent variable. The R-squared results indicate that 0.65% of the movement in the dependent variable personal bankruptcy filings is explained by the severity of a flooding event and other independent variables. Research limitations/implications: The severity of the flooding event is measured using dollar losses incurred by the National Flood Insurance program. A macro-case study was undertaken, but the research results would have been enhanced by examining local areas and demographic factors that may have made bankruptcy filing following a flooding event more or less likely. Practical implications: The paper considers the impact of the natural disaster flooding on bankruptcy rates filings. The findings may have implications for multi-family properties as well as single-family housing. Purchasing flood insurance generally mitigates the likelihood of severe financial risk to the property owner. Social implications: Natural flood insurance is underwritten by the federal government and/or by private insurers. The financial health of private property insurers that underwrite flooding and their ability to meet losses incurred needs to be carefully scrutinized by the insured. Originality/value: Prior studies analyzing the linkages existing between housing prices, natural disasters and bankruptcy used descriptive data, mostly percentages, when considering this association. The study herein posits the same questions as these prior studies but used regression analysis to analyze the linkages. The methodology enables additional independent variables to be added to the analysis. [ABSTRACT FROM AUTHOR]

Default options may provide a low-cost way of influencing behaviour without modifying incentives and constraining choices between alternatives. However, an improved understanding is needed on whether they are effective when individuals have experience with making the choice in practice and have preferences for specific alternatives. We study whether defaults can be used to increase insurance coverage against low-probability/high-impact risks, like floods, and whether past flood insurance purchases and flooding experience moderate the effect of defaults. Our study uses a naturally occurring difference in experience, comparing the surveyed flood insurance choices of 1,187 homeowners, half of whom are in the Netherlands, where flood insurance penetration rates are low and recent flooding caused minor losses, and the other half of whom are in the United Kingdom (UK), where the opposite is true. We find defaults are effective amongst homeowners with little to no flood-related experience: in the Netherlands defaults increase the likelihood of insuring by between 17 and 18 percentage points. Although there is no overall effect of defaults in the UK, defaults increase flood insurance coverage for risk averse individuals, and those who have no reported previous flood experience and have not purchased flood insurance. Anticipated regret about not having insurance coverage in the event of a flood, and perceptions about the insurance cost explain between 34 and 37 percent of the relationship between the default and flood insurance demand. We discuss policy implications of our findings. [ABSTRACT FROM AUTHOR]

Background In market-based systems, the possibility to switch is an important precondition for a well-functioning health insurance market. To assess whether such a market works as intended, insight into the considerations and perceived barriers of insured is needed. This study examines the rates and reasons for not switching health insurer in the Netherlands, and whether these reasons differ between the general population and the population of people with a chronic illness. Methods We made use of survey data collected in 2017 among two panels representing the general population (n  = 659, response 44%) and the chronically ill population (n  = 1593, response 86%). Results We found differences regarding the reasons for not switching insurer. The chronically ill population seems to attach more importance to reasons related to the coverage of the health plan, whereas the general population is more focused on the level of service. Some people who considered switching experienced barriers, however, these barriers were not significantly more experienced by the chronically ill population. Conclusions This study reveals differences between the general population and the chronically ill population when examining reasons for not switching related to quality and coverage. A subset from the people who initially considered to switch experienced barriers which might have altered their decision. Further research is recommended to include questions about information search behaviour to examine which consumers make an informed decision for not switching, and for whom barriers limit switching. [ABSTRACT FROM AUTHOR]

Background: HIV status disclosure facilitates receipt of HIV prevention and treatment services. Although disclosure to sexual partners, family members or friends has been extensively studied, disclosure to community-based HIV programs is missing. This study assesses the magnitude of, and factors associated with undisclosed HIV status to a community-based HIV prevention program among caregivers of orphans and vulnerable children (OVC) in Tanzania. Methods: Data are from the USAID-funded Kizazi Kipya project that seeks to increase uptake of HIV, health, and social services by OVC and their caregivers in Tanzania. Data on OVC caregivers who were enrolled in the project during January–March 2017 in 18 regions of Tanzania were analyzed. Caregivers included were those who had complete information on their HIV status disclosure, household socioeconomic status, and sociodemographic characteristics. HIV status was self-reported, with undisclosed status representing all those who knew their HIV status but did not disclose it. Multilevel mixed-effects logistic regression, with caregivers' HIV status disclosure being the outcome variable was conducted. Results: The analysis was based on 59,683 OVC caregivers (mean age = 50.4 years), 71.2% of whom were female. Of these, 37.2% did not disclose their HIV status to the USAID Kizazi Kipya program at the time of enrollment. Multivariate analysis showed that the likelihood of HIV status non-disclosure was significantly higher among: male caregivers (odds ratio (OR) = 1.22, 95% confidence interval (CI) 1.16–1.28); unmarried (OR = 1.12, 95% CI 1.03–1.23); widowed (OR = 1.12, 95% CI 1.07–1.18); those without health insurance (OR = 1.36, 95% CI 1.28–1.45); age 61 + years (OR = 1.72, 95% CI 1.59–1.88); those with physical or mental disability (OR = 1.14, 95% CI 1.04–1.25); and rural residents (OR = 1.58, 95% CI 1.34–1.86). HIV status non-disclosure was less likely with higher education (p < 0.001); and with better economic status (p < 0.001). Conclusion: While improved education, economic strengthening support and expanding health insurance coverage appear to improve HIV status disclosure, greater attention may be required for men, unmarried, widowed, rural residents, and the elderly populations for their higher likelihood to conceal HIV status. This is a clear missed opportunity for timely care and treatment services for those that may be HIV positive. Further support is needed to support disclosure in this population. [ABSTRACT FROM AUTHOR]

Background There have been contributions to quantify the volume of low-value care practices in the USA, Canada and Australia but we have no knowledge about the volume in Europe. The purpose of this study was to assess the volume and variation of Dutch low-value care practices. Methods We conducted a cross-sectional study with data of a Dutch healthcare insurance company from general practioners (GP's) and hospitals in the Netherlands from 2016. We used all billing claims made by healthcare providers of 3.5 million Dutch inhabitants. We studied Choosing Wisely recommendations in order to select low-value care practices. We used the percentage low-value care practices per hospital and number of low-value care practices per GP as outcomes. Results We assessed the volume of low-back imaging by GPs, screening of patients over 75 years for colorectal cancer and diagnosing varices with Doppler or Plethysmography. We found that 0.4% (range 0–7%) of the eligible patients received low-value screening for colorectal cancer and 8.0% (range 0–88%) of eligible patients received low-value diagnosing of varices. About 52.4% of the GPs ordered X-rays and 11.2% ordered magnetic resonance imagings of the lumbosacral spine. Most healthcare providers did not provide the measured low-value care practices. However, 1 in 12 GPs ordered at least one low-back X-ray a week. Conclusions The three Choosing Wisely recommendations showed a lot of practice variation; many healthcare providers did not order these low-value diagnostic tests; a minor part did order a substantial amount, low-back spine radiology in particular. These healthcare providers should start reducing these activities. [ABSTRACT FROM AUTHOR]

This article puts contemporary debates about the relationship between immigration policy and the welfare state in historical perspective. Relying on new historical data, the article examines the relationship between immigration policy and social policy in Western Europe in the late 19th and early 20th centuries, when the modern welfare state emerged. Germany already had comparably strict immigration policies when the German Empire introduced the world's first national social insurances in the 1880s. Denmark, another early social-policy adopter, also pursued restrictive immigration policies early on. Almost all other countries in Western Europe started out with more liberal immigration policies than Germany's and Denmark's, but then adopted more restrictive immigration policies and more generous social policies concurrently. There are two exceptions, Belgium and Italy, which are discussed in the article. [ABSTRACT FROM AUTHOR]

This scoping review explored healthcare-related factors associated with symptom persistence, deterioration, or improvement in patients with persistent somatic symptoms (PSS) across Europe. Articles were systematically searched in PubMed, Web of Science, Cochrane Library, and PsycINFO by combining terms of PSS and healthcare-related factors. Studies published in English, German, Polish, or Dutch between 2000 and 2022 were included. Healthcare-related factors associated with PSS symptom course were investigated, and study quality assessed (Center for Evidence-Based Medicine Checklist, Newcastle-Ottawa Scale). Of 8386 identified studies, 56 were included in the analysis. A significant knowledge gap was evident, as most studies lacked comprehensive healthcare descriptions with particularly unclear definitions of "treatments as usual" in RCTs. The only extractable healthcare factor according to Andersen's Behavioral Model was the treatment setting. Rates of PSS improvement split by care-levels were 38% in primary, 44% in secondary, 25% in mixed, and 71% in specialized care. Persistence rates were 57%, 50%, 75%, and 29% respectively. Deterioration was observed in 5% of primary and 6% of secondary care studies. Studies were skewed toward the United Kingdom, Germany, and the Netherlands. This scoping review shed light on the association between care levels and symptom outcomes in PSS patients. However, limited information in the current studies constrained our exploration of associations with other factors and symptom outcomes. Important aspects, like care availability, referral processes, and insurance coverage, are yet to be elucidated. Addressing these gaps is pivotal for developing targeted treatments across Europe, ultimately enhancing PSS patients' outcomes. • Review of association between healthcare factors and persistent somatic symptoms. • Treatment setting as a healthcare factor associated with the course of symptoms. • Persistent somatic symptoms improvement rates were highest in specialized care. • Studies often lack a clear description of care for persistent somatic symptoms. • Detailed health care reporting is needed to uncover additional crucial factors. [ABSTRACT FROM AUTHOR]

We construct two examples of shareholder networks in which shareholders are connected if they have shares in the same company. We do this for the shareholders in Turkish companies and we compare this against the network formed from the shareholdings in Dutch companies. We analyse the properties of these two networks in terms of the different types of shareholder. We create a suitable randomised version of these networks to enable us to find significant features in our networks. For that we find the roles played by different types of shareholder in these networks, and also show how these roles differ in the two countries we study. [ABSTRACT FROM AUTHOR]

This article discusses recent developments in and new principles of European social health insurance (SHI). It analyses how privatization policies and competition have altered social insurance and whether financial difficulties are caused by social insurance features not evident in other types of health care systems. There is little if any evidence that SHI causes higher cost increases than other types of systems. The comparison of five European SHI systems demonstrates that despite cost containment policies these countries do not experience a trust crisis in health care or loss in support among the public. The author shows that SHI has moved toward universal health care and that the traditional values of solidarity and social security have even been strengthened over the past decades. [ABSTRACT FROM AUTHOR]

Post-flood policies and compensation regimes tend to focus on the resilience of public spaces and improving the adaptive capacity of future private property developments. This article focuses on the instruments associated with the resilience of existing privately owned residential buildings from the perspective of post-flood policies and compensation regimes. By reviewing the relevant legal and policy landscapes it aims to provide mutual lessons learned between the EU, its member states and the US and to set forth generally applicable recommendations for improving post-flood policies for existing buildings. [ABSTRACT FROM AUTHOR]

The aim of this cross‐sectional study was to assess differences in caries experience according to socio‐economic status (SES) in a health‐care system with full coverage of dental costs for children up to the age of 18 yr. In 2011 and 2014, by performing hurdle negative binomial models, we obtained data on 3,022 children and young adults aged 5, 8, 11, 14, 17, 20, and 23 yr, living in four cities in the Netherlands. At all ages between 5 and 23 yr, the percentages of children with caries‐free dentitions were lower and mean caries experience were higher in low‐SES than in high‐SES participants. In 5‐yr‐old children with dmft > 0, mean caries experience was 3.6 in those with low SES and 2.3 in those with high SES. In 23‐yr‐old participants, these estimates were 6.8 and 4.4, respectively (P < 0.05). Low‐SES children have a greater risk of more caries experience than high‐SES children. Thus, in a system with full free paediatric dental coverage, socio‐economic inequality in caries experience still exists. Dental health professionals, well‐child care doctors and nurses, general practitioners, and elementary school teachers should collaborate to promote oral health at the community level, with specific targeting of low‐SES families. We further need policy measures to curtail, at community level, the increasing availability and consumption of highly processed, carbohydrate‐rich foods, with particular attention for low‐SES families. [ABSTRACT FROM AUTHOR]

This article examines the universalization of long-term services and supports (LTSS) in three countries that have reformed LTSS funding in the past ten to fifteen years--Scottish and Spanish reforms extending public insurance to everyone needing LTSS, and the Dutch reform, which rolled back Europe's older funding system. Although universal systems save health systems money and improve the financial well-being of families, attention should be paid to subsidy designs, the role of needs tests to modulate demand, and the development of home- and community-based services. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to determine which factors influence the choice to adopt subsidized multi-peril crop insurance (MPCI) in the Netherlands and whether prior hail insurance uptake is one of the determinants of MPCI adoption. In addition, it is analyzed whether subsidized MPCI has reduced disaster relief spending.Design/methodology/approach Cross-sectional survey with 512 respondents using a stratified design comprising MPCI adopters and non-adopters sampled from the Dutch national census data base. The national census, including information on subsidized MPCI adoption from 2010 up to and including 2015, was supplemented with information on (prior) traditional market-based hail insurance uptake, and other underlying determining factors were elicited. Logistic regression analysis was used to determine which factors influence the choice to adopt MPCI.Findings Analysis of MPCI adoption reveals that subsidized MPCI mainly substituted for market-based hail insurance uptake up to now. Growers who did not insure against hail in the past were hardly reached. Approximately, three-quarter of MPCI adopters insured hail prior to market introduction of MPCI. In the arable sector, MPCI adoption was 2.89 (p<0.01) more likely for prior hail insurance adopters compared to non-adopters, while it was 9.67 (p<0.01) more likely in the fruit sector.Research limitations/implications In the arable sector, it is expected that MPCI uptake in the coming years will reach more prior non-adopters of hail insurance as demand is expected to increase. Prior hail insurance adopters in the arable sector can be seen as the early MPCI adopters. In the fruit sector, adoption rates are already at a relative high level and a further significant increase by targeting non-adopters of hail insurance is not likely.Originality/value Governmental support has crowded out to some extend traditional market-based hail insurance in the Netherlands. Since the Common Agricultural Policy of the European Union is creating more momentum to subsidize crop insurance more member states with a long history of a mature hail insurance market may be confronted with similar crowding-out effects. [ABSTRACT FROM AUTHOR]

We exploit an age discontinuity in a Dutch disability insurance reform to identify the health impact of stricter eligibility criteria and reduced generosity. Our results show substantial adverse effects on life expectancy for women subject to the more stringent criteria. A €1,000 reduction in annual benefits leads to a 2.4 percentage points higher probability of death more than 10 years after the reform. This negative health effect is restricted to women with low pre-disability earnings. We find that the mortality rate of men subject to the stricter rules is reduced by 0.7 percentage points. The evidence for the existence of substantial health effects implies that policymakers considering a disability insurance reform should carefully balance the welfare gains from reduced moral hazard against losses not only from less coverage of income risks but also from deteriorated health. [ABSTRACT FROM AUTHOR]

We investigate whether interventions by (a) medical doctors and (b) occupational specialists are effective in reducing sick leave durations among self-employed workers. Therefore, we exploit unique administrative data comprising all sick leave claims by self-employed workers insured with a major Dutch private insurer between January 2009 and March 2014. We estimate a multivariate duration model dealing with nonrandom selection into the two intervention types by controlling for observable and unobservable claimant characteristics. We find adverse treatment effects for both interventions, irrespective of whether they are started early or (middle) late in the sickness spell. [ABSTRACT FROM AUTHOR]

Importance: A higher out-of-pocket price for mental health care may lead not only to cost savings but also to negative downstream consequences.Objective: To examine the association of higher patient cost sharing with mental health care use and downstream effects, such as involuntary commitment and acute mental health care use.Design, Setting, and Participants: This difference-in-differences study compared changes in mental health care use by adults, who experienced an increase in cost sharing, with changes in youths, who did not experience the increase and thus formed a control group. The study examined all 2 780 558 treatment records opened from January 1, 2010, through December 31, 2012, by 110 organizations that provide specialist mental health care in the Netherlands. Data analysis was performed from January 18, 2016, to May 9, 2017.Exposures: On January 1, 2012, the Dutch national government increased the out-of-pocket price of mental health services for adults by up to €200 (US$226) per year for outpatient treatment and €150 (US$169) per month for inpatient treatment.Main Outcomes and Measures: The number of treatment records opened each day in regular specialist mental health care, involuntary commitment, and acute mental health care, and annual specialist mental health care spending.Results: This study included 1 448 541 treatment records opened from 2010 to 2012 (mean [SD] age, 41.4 [16.7] years; 712 999 men and 735 542 women). The number of regular mental health care records opened for adults decreased abruptly and persistently by 13.4% (95% CI, -16.0% to -10.8%; P < .001) per day when cost sharing was increased in 2012. The decrease was substantial and significant for severe and mild disorders and larger in low-income than in high-income neighborhoods. Simultaneously, in 2012, daily record openings increased for involuntary commitment by 96.8% (95% CI, 87.7%-105.9%; P < .001) and for acute mental health care by 25.1% (95% CI, 20.8%-29.4%; P < .001). In contrast to our findings for adults, the use of regular care among youths increased slightly and the use of involuntary commitment and acute care decreased slightly after the reform. Overall, the cost-sharing reform was associated with estimated savings of €13.4 million (US$15.1 million). However, for adults with psychotic disorder or bipolar disorder, the additional costs of involuntary commitment and acute mental health care exceeded savings by €25.5 million (US$28.8 million).Conclusions and Relevance: Higher cost sharing for seriously ill and low-income patients could discourage treatment of vulnerable populations and create substantial downstream costs. [ABSTRACT FROM AUTHOR]

Background: Exclusions are used by insurers to neutralize higher than average risks of sickness absence (SA). However, differentiating risk groups according to one's medical situation can be seen as discrimination against people with health problems in violation of a 2006 United Nations convention. The objective of this study is to investigate whether the risk of SA of insured persons with exclusions added to their insurance contract differs from the risk of persons without exclusions. Methods: A dynamic cohort of 15 632 applicants for private disability insurance at a company insuring only college and university educated self-employed in the Netherlands. Mean follow-up was 8.94 years. Duration and number of SA periods were derived from insurance data to calculate the hazard of SA periods and of recurrence of SA periods. Results: Self-employed with an exclusion added to their insurance policy experienced a higher hazard of one or more periods of SA and on average more SA days than self-employed without an exclusion. Conclusion: Persons with an exclusion had a higher risk of SA than persons without an exclusion. The question to what extent an individual should benefit from being less vulnerable to disease and SA must be addressed in a larger societal context, taking other aspects of health inequality and solidarity into account as well. [ABSTRACT FROM AUTHOR]

In health insurance, voluntary deductibles are offered to the insured in return for a premium rebate. Previous research has shown that 11 % of the Dutch insured opted for a voluntary deductible (VD) in health insurance in 2014, while the highest VD level was financially profitable for almost 50 % of the population in retrospect. To explain this discrepancy, this paper identifies and discusses six potential determinants of the decision to opt for a VD from the behavioral economic literature: loss aversion, risk attitude, ambiguity aversion, debt aversion, omission bias, and liquidity constraints. Based on these determinants, five potential strategies are proposed to increase the number of insured opting for a VD. Presenting the VD as the default option and providing transparent information regarding the VD are the two most promising strategies. If, as a result of these strategies, more insured would opt for a VD, moral hazard would be reduced. [ABSTRACT FROM AUTHOR]

Background: To explore changes in utilization patterns for general practice (GP) and hospital care of people living in deprived neighbourhoods when primary care providers work in a more coherent and coordinated manner by applying an integrated approach.Methods: We compared expected (based on consumption patterns of a health insurers' total population) and actual utilization patterns in a deprived Dutch intervention district in the city of Utrecht (Overvecht) with control districts 1 (Noordwest) and 2 (Kanaleneiland) over the period 2006-2011, when an integrated care approach was increasingly provided in the intervention district. Standardized insurance claims data were used to indicate use of GP care and hospital care.Results: Our findings revealed that the utilization of total GP care increased more in the intervention district than in the control districts. And that the intervention district showed a more pronounced decreasing trend in total hospital use as compared to what was expected, in particular from 2008 onwards. In addition, we observed a change in type of GP care use in the intervention district in particular: the number of regular consultations, long consultations, GP home visits and evening, night and weekend consultations were increasingly higher than expected. The intervention district also showed the largest decrease between actual and expected use of ambulatory care, clinical care and 1-day hospitalizations.Conclusions: Utilization patterns for general practice and hospital care of people living in deprived districts may change when primary care professionals work in a more coherent and coordinated manner by applying a more 'comprehensive' integrated care approach. Results support the expectation that a comprehensive integrated care approach might eventually contribute to the future sustainability of healthcare systems. [ABSTRACT FROM AUTHOR]

The author reflects on the aspects of the Dutch supplementary health insurance (SHI) and the insurance theory. Topics discussed include the mandatory basic health insurance (BHI) covered by SHI which include physiotherapy, dental care, and dental care, the limited risk reduction from SHI because it does not covered large losses, and the implication of behavioural economics on the demand for health insurance.

This paper provides new field evidence on the role of probability numeracy in health insurance purchase. Our regression results, based on rich survey panel data, indicate that the expenditure on two out of three measures of health insurance first rises with probability numeracy and then falls again. This non-monotonic relationship suggests that probability numeracy affects health insurance decisions through several channels. In the third case-the obligatory Dutch basic health insurance-we find that high levels of probability numeracy coincide with a lower deductible choice. We discuss possible explanations for the patterns we find, including status quo bias and ambiguity aversion, and the related policy implications. [ABSTRACT FROM AUTHOR]

This article investigates efficiency and competition in the Dutch life insurance market by estimating unused scale economies and measuring efficiency-market share dynamics during 1995-2010. Large unused scale economies exist for small- and medium-sized life insurers, indicating that further consolidation would reduce costs. Over time average scale economies decrease but substantial differences between small and large insurers remain. A direct measure of competition confirms that competitive pressure is lower than in other markets. We do not observe any impact of increased competition from banks, the so-called investment policy crisis or the credit crisis, apart from lower returns in 2008. [ABSTRACT FROM AUTHOR]

Children and adolescents in the United States have been found to be less healthy than their counterparts in other high-income countries. The contribution of pediatric health care use to health outcomes--either as an independent determinant or as a mediator of wider social factors--is not well understood. We found that, compared to their peers in the Netherlands, US children and adolescents had fewer annual doctor and dental contacts in 2012. In both countries, poorer health status was reported among low-income compared to high-income children; however, this status was accompanied by greater or equal number of doctor and dental contacts among low-income Dutch children compared to their higher-income Dutch peers. By contrast, low-income US children had 28-65 percent fewer care episodes than high-income US children. Further research is needed to investigate the potential impact of greater equity and use of pediatric services on US health outcomes. Possible policy responses might include a focus on improving the quality, coverage, and benefits of health insurance, as well as on the workforce implications of providing high-quality pediatric care to all. [ABSTRACT FROM AUTHOR]

As recently as 15 years ago, the high level of Disability Insurance (DI) enrollment was considered to be one of the major social and economic problems of the Netherlands; indeed, the Netherlands was characterized as the country with the most out-of-control disability program of OECD countries. But since about 2002, the Netherlands has seen a spectacular decline in its Disability Insurance enrollment rate. Radical reforms to the Dutch DI system were implemented over the period 1996 to 2006. We cluster these reforms in three broad categories: 1) reducing the incentives of employers to move workers to disability; 2) increased gatekeeping; and 3) tightening disability eligibility criteria while enhancing worker incentives. The reforms appear to have been very effective. Since 2002, yearly DI inflow rates dropped from 1.5 percent in 2001 to about 0.5 percent of the insured population in 2012. We argue that particularly the interaction of employer incentives and formal employer obligations has contributed to the substantial decrease in DI inflow. On the downside, however, it seems workers with bad health have sorted into temporary employment-without employers bearing the financial responsibility of their benefit costs. [ABSTRACT FROM AUTHOR]

In many countries, if not all, the autonomy of minors is limited. Especially in countries with comprehensive legislation in the field of health law the (lack of) autonomy of minors may create challenges. These problems become more complex if the costs of treatment are not paid by the government or covered by insurance. Some challenges are: At what age is a minor able to decide about his health? As not every treatment is the same, how should the system take this into account? The Netherlands has a long history of very comprehensive health care legislation. This legislation includes a section about the treatment of minors that addresses the questions of the conditions in which the autonomy of minors is limited. Though this legislation is limited to the Netherlands other countries face the same challenges. [ABSTRACT FROM AUTHOR]

We aimed to identify common elements in work sickness absence (SA) in Spain, Sweden and The Netherlands. We estimated basic statistics on benefits eligibility, SA incidence and duration and distribution by major diagnostics. The three countries offer SA benefits for at least 12 months and wage replacement, differing in who and when the payer assumes responsibility; the national health systems provide health care with participation from occupational health services. Episodes per 1000 salaried workers and episode duration varied by country; their distribution by diagnostic was similar. Basic and useful SA indicators can be constructed to facilitate cross-country comparisons. [ABSTRACT FROM AUTHOR]

Under the Patient Protection and Affordable Care Act (ACA), consumer choice plays a critical role: it drives the competitive market in health insurance plans that will operate through health insurance exchanges. As the 2014 deadline for establishing exchanges approaches, states face choices: they can either allow the federal government to manage an exchange on their behalf; take on a minimalist role by managing a state exchange or partnering with the federal exchange; or assume an activist role-by aiming to influence the price, design, and quality of the health insurance options available through exchanges and taking steps to support consumers' ability to choose among these options. This article discusses states' choices and the governance issues that they raise, first by describing the extent of discretion that states have in shaping the range of health plans on offer as well as the issues they will need to consider in choosing an exchange model. We then discuss the considerable body of evidence that addresses how people behave in individual insurance markets, concluding that it strongly supports the need for states to take an active role in shaping health insurance exchanges and ensuring that they support consumer choice. [ABSTRACT FROM AUTHOR]

Aims To examine the impact of two national tobacco control interventions in the past decade on (dispensed) prescriptions of stop-smoking medication. Design Ecological study with interrupted time-series analyses of quarterly data points of three nation-wide representative databases. Setting The Netherlands 2001-2012, with the introduction of the guideline for smoking cessation care for general practitioners ( GP) in 2007 and full insurance coverage for smoking cessation treatment in 2011. Participants GPs, pharmacists and people in the general population aged 15 years and older. Measurements Time-series plots were inspected visually and segmented regression analyses were performed to estimate the change in level and slope of (dispensed) prescriptions of stop-smoking medication and smoking prevalence in the years preceding and after the tobacco control interventions. Findings No measurable effects of the GP guideline on (dispensed) prescriptions were observed. Shortly after the start of health insurance coverage, an estimated increase in primary care prescriptions of 6.3 per 1000 smokers [95% confidence interval ( CI) = 2.9-9.8; P = 0.001] and 17.3 dispensed items per 1000 smokers (95% CI = 12.5-22.0; P < 0.000) was accompanied by a sudden drop in smoking prevalence of 2.9% (95% CI = 4.6-1.1; P = 0.002) in the first quarter of 2011. Immediately after the coverage abolition, smoking prevalence increased by 1.2% (95% CI = 0.5-2.8; P = 0.156) and dispensed prescription rates decreased with 21.6 per 1000 smokers (95% CI = 26.0-17.2; P < 0.000). Conclusions Full health insurance coverage for smoking cessation treatment in the Netherlands was accompanied by a significant increase in the number of (dispensed) prescriptions of stop-smoking medication and a decrease in smoking prevalence. [ABSTRACT FROM AUTHOR]

The United States is in the midst of the most sweeping health insurance expansions and market reforms since the enactment of Medicare and Medicaid in 1965. Our 2013 survey of the general population in eleven countries-Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States-found that US adults were significantly more likely than their counterparts in other countries to forgo care because of cost, to have difficulty paying for care even when insured, and to encounter time-consuming insurance complexity. Signaling the lack of timely access to primary care, adults in the United States and Canada reported long waits to be seen in primary care and high use of hospital emergency departments, compared to other countries. Perhaps not surprisingly, US adults were the most likely to endorse major reforms: Three out of four called for fundamental change or rebuilding. As US health insurance expansions unfold, the survey offers benchmarks to assess US progress from an international perspective, plus insights from other countries' coverage-related policies. [ABSTRACT FROM AUTHOR]

Since the 1990s some European countries have had regulated health insurance exchanges or have incorporated elements of exchange markets into their health systems. Health reforms in Switzerland and the Netherlands in 1996 and 2006, respectively, created managed competition in the countries' health insurance markets, which are somewhat analogous to the US state and federally operated health insurance exchanges scheduled to begin operations in 2013 under the Affordable Care Act. We review the Swiss and Dutch experience with exchanges and offer specific lessons for the US exchanges. First, risk-adjustment mechanisms-which provide premium adjustments intended to compensate health plans for enrolling people expected to have high medical costs-need to be sophisticated and continually updated. Second, it is important to determine why people eligible for coverage don't enroll and to craft responses that will overcome enrollment barriers. Third, applying for subsidies must be simple. Fourth, insurers will need bargaining power similar to that of providers to create a level playing field for negotiating about prices and quality of services, and interim cost containment measures may be necessary. Fifth and finally, insurers and consumers alike will need meaningful information about providers' costs and quality of care so they can become prudent purchasers of health services, since managed competition among health plans by itself will not substantially drive down health costs. [ABSTRACT FROM AUTHOR]

In the past one of the main challenges to households was that of coping with adversity. War, plague, famine, and flood were a constant threat, and could reduce what little improvements families had made in productivity. Economic growth therefore required a means of absorbing external adversities. To see how well late medieval households coped with adversity, this investigation focuses on the households of a small town and its surroundings in early modern Holland. Our findings reveal that several severe external shocks around 1500 had little effect on the general level or distribution of wealth, which suggests that certain forms of insurance may have protected the population. The results show that households increasingly invested in capital markets rather than employing such techniques as scattered holdings and hoarding. This fact indicates that such investment played a vital role in a household's risk aversion strategy. The change from unproductive to more productive risk-aversion strategies also provides some clues about progress with respect to insurance during Holland's financial revolution. [ABSTRACT FROM AUTHOR]

This article is an empirical study of the interrelationship between (subsidized) legal aid and legal expenses insurance (LEI) in the Netherlands. Is LEI a system that is relevant only to the high-income groups that are not eligible for legal aid? Is it therefore a complement to legal aid? Or is LEI also of interest to lower-income groups, and can it serve as a substitute? Our analysis is based on data from the second wave of the Dutch Paths to Justice Survey held in 2009. We first study how the holdership of LEI policies is distributed among the population in general and among income classes in particular. We then discuss how the incidence of justiciable problems interrelates with the possession of LEI. Next, we study how the possession of LEI affects the responses to justiciable problems. Do people take action? Do they seek legal advice? From which sources? Finally, we take a look at the results. Comparing the respondents with and without LEI in various income classes, we try to answer the central question: Complement or substitute? We conclude that a shift from legal aid to LEI has some clear disadvantages for low-income citizens, but these may well be compensated for by some important advantages, brought to the fore by our empirical data. [ABSTRACT FROM AUTHOR]

In recent years, the concepts of charity and development aid have changed significantly. Present concepts combine direct money transfer with co-production, knowledge sharing and the development of products and services designed for the need of developing and transition economies. The concept of micro-financing is a financial service which has proven to allow for entrepreneurs in the respective countries to start up their businesses. A relatively new financial product for these countries is micro-insurance. This article deals with the question whether consumers in the Netherlands are willing to donate micro-insurances and which factors influence this willingness to contribute to the non-profit micro-insurance approach of an insurance company. The data were collected with questionnaires among a sample of the Dutch population ( N = 504). The data have been processed in a one-way between-groups ANOVA, a paired sample t test and an ordinal regression analysis. The results show that approximately half of the Dutch consumers are willing to pay an additional amount on their insurance premium for the donation of micro-insurances. The amount of the insurance premium did, however, not affect the willingness to donate (WTD). If consumers could choose the beneficiary less people are willing to donate, yet those people are willing to donate more money. In conclusion, there is readiness among consumers to contribute to micro-insurance via an insurance company that assists in setting up micro-insurance projects. This indicates a possible role for companies to act as an intermediary between philanthropic acts and consumers. [ABSTRACT FROM AUTHOR]

Since the deregulation of the European insurance market in 1994, Dutch nonlife insurance firms have sized up and increased their focus. Concurrently, the stock organizational form has become increasingly dominant. This article investigates these 1995-2005 trends from a cost-efficiency perspective. We observe substantial economies of scale that are even larger for smaller firms. In line with the efficient structure hypothesis, both stocks and mutuals are found to have comparative cost advantages. Supporting the strategic focus hypothesis, we find that more specialized insurers have lower costs. Thick frontier efficiency estimates point to large cost X-inefficiencies that have moderately decreased over time. [ABSTRACT FROM AUTHOR]

In his seminal work The New Social Question, Pierre Rosanvallon reflects upon the impact of increasing knowledge about risks on solidarity (see Rosanvallon, 2000). He argues that increasing knowledge about social risks might hollow out the principle of solidarity. Although Rosanvallon's thesis has received significant scholarly attention, it hardly has been empirically tested. This article tries to fill this gap. It sets out to assess the impact of increasing knowledge about social risks on modern welfare states. It focuses on developments in the fields of pensions, health insurances, and unemployment insurances in the Netherlands. [ABSTRACT FROM AUTHOR]

The yearly increase in the number of natural catastrophes is tangible and most probably to persist. It is therefore necessary to build a legal framework that can respond timely and efficiently to events of this scale by formulating a structural, comprehensive and efficient compensation model. This article aims, first, at giving policymakers and legal scholars some clear starting points for setting up such a compensation model to the victims of a natural catastrophe. The article will, second, sketch the compensation systems in Belgium and the Netherlands, discussing only the main compensation regime specifically designed for victims of natural catastrophes. Third and finally, these two systems will be compared using the insights from the economic analysis of law. [ABSTRACT FROM AUTHOR]

This 2010 survey examines the insurance-related experiences of adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United States, and the United Kingdom. The countries all have different systems of coverage, ranging from public systems to hybrid systems of public and private insurance, and with varying levels of cost sharing. Overall, the study found significant differences in access, cost burdens, and problems with health insurance that are associated with insurance design. US adults were the most likely to incur high medical expenses, even when insured, and to spend time on insurance paperwork and disputes or to have payments denied. Germans reported spending time on paperwork at rates similar to US rates but were well protected against out-of-pocket spending. Swiss out-of-pocket spending was high, yet few Swiss had access concerns or problems paying bills. For US adults, comprehensive health reforms could lead to improvements in many of these areas, including reducing differences by income observed in the study. [ABSTRACT FROM AUTHOR]

The article deals with the decision of the Dutch Ministry of Health to impose mandatory private insurance as part of the healthcare reforms introduced in 2006. Issues that contributed to the introduction of the 2006 reforms are traced. It describes the state of quality of care in the Netherlands as discussed in the first "Dutch Health Care Performance Report." The health care reforms were reportedly designed to challenge health insurers to increase the efficiency of health care by providing the basic healthcare package benefits to anyone who avails. Also discussed are the benefits gained from the reforms and their impact on health professionals.

Understanding how health care utilization responds to cost-sharing is of central importance for providing high quality care and limiting the growth of costs. We study whether the framing of cost-sharing incentives has an effect on health care utilization. For this we make use of a policy change in the Netherlands. Until 2007, patients received a refund if they consumed little or no health care; the refund was the lower the more care they had consumed. From 2008 onward, there was a deductible. This means that very similar economic incentives were first framed in terms of smaller gains and later as losses. We find that patients react to incentives much more strongly when they are framed in terms of losses. The effect on yearly spending is 8.6 percent. This suggests that discussions on the optimal design of cost-sharing incentives should also revolve around the question how these are presented to patients. [ABSTRACT FROM AUTHOR]

Policy analysts consider the Netherlands health system a possible model for the United States. Since 2006 all Dutch citizens have to buy standardized individual health insurance coverage from a private insurer. Consumers have an annual choice among insurers, and insurers can selectively contract or integrate with health care providers. Subsidies make health insurance affordable for everyone. A Risk Equalization Fund compensates insurers for enrollees with predictably high medical expenses. The reform is a work in progress. So far the emphasis has been on the health insurance market. The challenge is now to successfully reform the market for the provision of health care. [ABSTRACT FROM AUTHOR]

The purpose of the paper is to assess the theory that the downside risk insurance provided by more generous welfare states generates long run efficiency gains, which counterbalance the short run efficiency losses caused by work disincentives in these states (Feldstein 1974, 1976; Sinn 1995, 1996). Testing downside risk theory requires long term data, so the paper makes use of the three longest running national socio-economic panel surveys. These are the American Panel Study of Income Dynamics (PSID, 1968-), the German Socio-Economic Panel (1984-) and the Dutch Socio-Economic Panel (SEP, 1984-). The paper focusses on prime age households (heads 25–59) and assesses their participation in and returns to adult education and job training. Our results indicate some support for the theory in so far as Dutch and German prime age adults, living in more generous welfare states, were much more likely than Americans to take the risk of foregoing current earnings and investing in additional education. In all three countries returns on investment were substantial. [ABSTRACT FROM AUTHOR]

Climate change is projected to cause severe economic losses, which has the potential to affect the insurance sector and public compensation schemes considerably. This article discusses the role insurance can play in adapting to climate change impacts. The particular focus is on the Dutch insurance sector, in view of the Netherlands being extremely vulnerable to climate change impacts. The usefulness of private insurance as an adaptation instrument to increased flood risks is examined, which is currently unavailable in the Netherlands. It is questioned whether the currently dominant role of the Dutch government in providing damage relief is justified from an economic efficiency perspective. Characteristics of flood insurance arrangements in the Netherlands, the United Kingdom, Germany, and France are compared in order to identify possible future directions for arrangements in the Netherlands. It is argued that social welfare improves when insurance companies take responsibility for part of the risks associated with climate change. [ABSTRACT FROM AUTHOR]

In this article, we assess the impact of financial incentives on the inflow in the public Disability Insurance (DI) scheme in The Netherlands. For this matter, the variation in replacement rates over different sectors is exploited to estimate the probability of DI enrolment over a sample of employees from the Dutch Income Panel (1996–2000). On the basis of these administrative data, we find a point estimate of the elasticity of DI enrolment with respect to the DI wealth rate of 2.5. Simulations indicate that a 5%-point rise in replacement rates in the two first years of DI increases DI enrolment by 6%. [ABSTRACT FROM AUTHOR]