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The effect of managed competition in Dutch social health insurance has resulted in price completion among insurance funds. The estimated premium elasticites of market share were 0.3 for compulsory coverage and 0.8 for supplementary coverage over the period of 1996-1998 in accordance with aggregate data from all insurance funds.

Innovation is widely recognized as an important means of tackling challenges that face healthcare systems. But innovation can only succeed in this role if financial conditions allow innovations with high societal value to be developed and implemented. This study is an in-depth examination of the role of payment mechanisms throughout the innovation process, from the perspective of innovators. We conducted a comparative case study of four innovation projects, two involving medical devices and two involving health information technologies, all of which originated from academic settings. Although financial factors were found to have impeded the progress of innovative products at every step in the innovation process, this effect appears to have been strongest during the implementation phase. The perceived commercial value of an innovative product was a key factor in obtaining sufficient payment. Innovative products with potentially significant societal value but limited commercial value are unlikely to become structurally embedded in practice, or to be scaled up beyond the local level. The study reveals four additional factors that affect progress through the healthcare innovation process: compatibility of the innovation with existing practice, and commitment, competences, and social capital of the innovator. We identify a number of lessons for policy and practice that we believe would increase the likelihood of innovations with potentially significant societal value to achieve widespread implementation. These lessons reflect three key issues identified in our research: 1) shift the focus from commercial value towards societal value; 2) support dissemination of innovations beyond the local level; 3) help innovators to convey their valuable ideas. • Payment mechanisms affect innovative devices and health information technologies differently. • The focus of payment mechanisms for healthcare innovations should be shifted from commercial to societal value. • Dissemination of valuable healthcare innovations beyond the local level should be (financially) supported. • Compatibility with existing practices improves the chances of obtaining payment and making progress. • Innovator commitment, competences, and social capital have an influence on healthcare innovation and payment allocation. [ABSTRACT FROM AUTHOR]

Within a healthcare system with managed competition, health insurers are expected to act as prudent buyers of care on behalf of their customers. To fulfil this role adequately, understanding consumer preferences for health plan characteristics is of vital importance. Little is known, however, about these preferences and how they vary across consumers. Using a discrete choice experiment (DCE) we quantified trade-offs between basic health plan characteristics and analysed whether there are differences in preferences according to age, health status and income. We selected four health plan characteristics to be included in the DCE: (i) the level of provider choice and associated level of reimbursement, (ii) the primary focus of provider contracting (price, quality, social responsibility), (iii) the level of service benefits, and (iv) the monthly premium. This selection was based on a literature study, expert interviews and focus group discussions. The DCE consisted of 17 choice sets, each comprising two hypothetical health plan alternatives. A representative sample (n = 533) of the Dutch adult population, based on age, gender and educational level, completed the online questionnaire during the annual open enrolment period for 2015. The final model with four latent classes showed that being able to choose a care provider freely was by far the most decisive characteristic for respondents aged over 45, those with chronic conditions, and those with a gross income over €3000/month. Monthly premium was the most important choice determinant for young, healthy, and lower income respondents. We conclude that it would be very unlikely for half of the sample to opt for health plans with restricted provider choice. However, a premium discount up to €15/month by restricted health plans might motivate especially younger, healthier, and less wealthy consumers to choose these plans. [ABSTRACT FROM AUTHOR]

Legislation that came into effect in 2006 has dramatically altered the health insurance system in the Netherlands, placing greater emphasis on consumer choice and competition among insurers. The potential for such competition depends largely on consumer preferences for price and quality of service by insurers and quality of affiliated providers. This study provides initial evidence on the preferences of Dutch consumers and how they view trade-offs between various aspects of health insurance product design. A key feature of the analysis is that we compare the responses of high and low risk individuals, where risk is defined by the presence of a costly chronic condition. This contrast is critically important for understanding incentives facing insurers and for identifying potential unanticipated consequences of market competition. The results from our conjoint analysis suggest that not only high risk but also low risk individuals are willing to pay substantially more for insurance products that can be shown to provide better health outcomes. This suggests that insurance products that are more expensive and provide better quality of care may also attract low risk individuals. Therefore, development and dissemination of good, reliable and understandable health plan performance indicators may effectively reduce the problem of adverse selection. [Copyright &y& Elsevier]