Hostname: page-component-8448b6f56d-xtgtn Total loading time: 0 Render date: 2024-04-23T09:04:56.067Z Has data issue: false hasContentIssue false
  • English
  • Français

Choice of providers and mutual healthcare purchasers: can the English National Health Service learn from the Dutch reforms?1

Published online by Cambridge University Press:  01 July 2010

Gwyn Bevan  and
Wynand P. M. M. van de Ven
Gwyn Bevan*
Affiliation:
Professor of Management Science, Department of Management, London School of Economics and Political Science, London, UK
Wynand P. M. M. van de Ven
Affiliation:
Professor of Health Insurance, Department of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
*
Correspondence to: Gwyn Bevan, Professor of Management Science, Department of Management, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK. Email: R.G.Bevan@lse.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

In the 1990s, countries experimented with two models of health care reforms based on choice of provider and insurer. The governments of the UK, Italy, Sweden and New Zealand introduced relatively quickly ‘internal market’ models into their single-payer systems, to transform hierarchies into markets by separating ‘purchasers’ from ‘providers’, and enabling ‘purchasers’ to contract selectively with competing public and private providers so that ‘money followed the patient’. This model has largely been abandoned where it has been tried. England, however, has implemented a modified ‘internal market’ model emphasising patient choice, which has so far had disappointing results. In the Netherlands, it took nearly 20 years to implement successfully the model in which enrollees choose among multiple insurers; but these insurers have so far only realised in part their potential to contract selectively with competing providers. The paper discusses the difficulties of implementing these different models and what England and the Netherlands can learn from each other. This includes exploration, as a thought experiment, of how choice of purchaser might be introduced into the English National Health Service based on lessons from the Netherlands.

Type
Articles
Information
Health Economics, Policy and Law , Volume 5 , Issue 3: Special Issue on Cross-Country Issues in Health Care: Choice, Equity, Efficiency and Cost , July 2010 , pp. 343 - 363
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

1

This paper was presented at the Autumn 2009 meeting of the European Health Policy Group.

References

Ashton, T., Mays, N.Devlin, N. (2005), ‘Continuity through change: the rhetoric and reality of health reform in New Zealand’, Social Science & Medicine, 61(2): 253–262.CrossRefGoogle ScholarPubMed
Audit Commission (1996), What the Doctor Ordered. A Study of GP Fundholders in England and Wales, London: HMSO.Google Scholar
Audit Commission (2008), The right result? Payment by results 2003–07, London: Audit Commission, http://www.audit-commission.gov.uk/nationalstudies/health/financialmanagemet/Pages/therightresult.aspxGoogle Scholar
Audit Commission and Healthcare Commission (2008), Is the Treatment Working?, London: Audit Commission, http://www.audit-commission.gov.uk/reports/NATIONAL-REPORT.asp?CategoryID=&ProdID=9F8B7F6A-214D-4165-BE65-716315270A82&fromREPORTSANDDATA=NATIONAL-REPORTGoogle Scholar
Bevan, G. (2006), ‘A third way’, British Medical Journal, 333: 252–253.CrossRefGoogle ScholarPubMed
Bevan, G. (2008), ‘Is choice working in the English National Health Service?’, British Medical Journal, 337: a935.CrossRefGoogle Scholar
Bevan, G. (2009), ‘The search for a proportionate care law by formula funding in the English NHS’, Financial Accountability and Management, 25(4): 391–410.CrossRefGoogle Scholar
Bevan, G., Helderman, J.-K.Wilsford, D. (2010), ‘Changing choices in health care: implications for equity, efficiency and cost’, Health Economics, Policy and Law, 5: 251–267.CrossRefGoogle ScholarPubMed
Bevan, G.Robinson, R. (2005), ‘The interplay between economic and political logics: path dependency in health care in England’, Journal of Health Politics, Policy and Law, 30(1): 53–78.CrossRefGoogle ScholarPubMed
Brereton, L.Vasoodaven, V. (2010), The Impact of the NHS Market, London: Civitas, http://www.civitas.org.uk/nhs/download/Civitas_LiteratureReview_NHS_market_Feb10.pdfGoogle Scholar
Carbone, C., Lecci, F.Liotta, A. (2008), ‘L’Aziendalizzazione della Sanità in Italia’, in E. Anessi Pessina and E. Cantù (eds), Rapporto OASI 2008, Milan: EGEA: 17–94.Google Scholar
Croxson, B. (1999), Organisational Costs in the New NHS, London: Office for Health Economics.Google Scholar
Day, P.Klein, R. (1991), ‘Britain’s health care experiment’, Health Affairs, 10(3): 39–59.CrossRefGoogle ScholarPubMed
Dixon, A., Robertson, R.Bal, R. (2010), ‘The experience of implementing choice at point of referral: a comparison of the Netherlands and England’, Health Economics, Policy and Law, 5: 295–317.CrossRefGoogle ScholarPubMed
Ellwood, P. M., Anderson, N. N., Billings, J. E., Carlson, R., Hoagberg, E.McClure, W. (1971), ‘Health maintenance strategy’, Medical Care, 9(3): 291–299.CrossRefGoogle ScholarPubMed
Enthoven, A. C. (1978), ‘Consumer-choice health plan; a national-health-insurance proposal based on regulated competition in the private sector’, New England Journal of Medicine, 298: 709–720.CrossRefGoogle ScholarPubMed
Enthoven, A. (1985), Reflections on the Management of the NHS, London: Nuffield Provincial Hospitals Trust.Google Scholar
Enthoven, A. C. (2000), ‘In pursuit of an improving National Health Service’, Health Affairs, 19(3): 102–119.CrossRefGoogle ScholarPubMed
Farrar, S., Sussex, J., Yi, D., Sutton, M., Chalkley, M., Scott, A.Ma, A. (2007), National Evaluation of Payment by Results, Aberdeen: Health Economics Research Unit, http://www.astrid-online.it/Politiche-/Studi--ric/HERU_report_dec07.pdfGoogle Scholar
Flood, C. M.Haugan, A. (2010), ‘Lessons for Canada from regulatory approaches to the public/private divide in Sweden, the UK, the Netherlands, Germany and France’, Health Economics, Policy and Law, 5: 319–341.CrossRefGoogle Scholar
Fung, C. H., Lim, Y.-W., Mattke, S., Damberg, C.Shekelle, P. G. (2008), ‘Systematic review: the evidence that publishing patient care performance data improves quality of care’, Annals of Internal Medicine, 148: 111–123.CrossRefGoogle ScholarPubMed
Glennerster, H., Matsaganis, M., Owens, P.Hancock, S. (1994), Implementing GP Fundholding, Buckingham: Open University Press.Google Scholar
Ham, C. (2007), ‘What to do with insolvent hospitals: will politicians allow providers to fail?’, British Medical Journal, 335: 170.CrossRefGoogle Scholar
Ham, C. (2008a), ‘Competition and integration in the English National Health Service’, British Medical Journal, 336: 805–807.CrossRefGoogle ScholarPubMed
Ham, C. (2008b), ‘World class commissioning: a health policy chimera?’, Journal Health Services Research Policy, 13(2): 116–121.CrossRefGoogle ScholarPubMed
Harrison, M. I.Calltorp, J. (2000), ‘The reorientation of market-oriented reforms in Swedish health-care’, Health Policy, 50(3): 219–240.CrossRefGoogle ScholarPubMed
Healthcare Commission (2008), The Annual Health Check 2007/08, London: Healthcare Commission, http://www.healthcarecommission.org.uk/_db/_documents/0708_annual_health_check_overview_document.pdfGoogle Scholar
Hood, C. (1995), ‘The “new public management” in the 1980s: variations on a theme’, Accounting, Organizations and Society, 20(2–3): 93–109.CrossRefGoogle Scholar
Klein, R. (2007), The New Politics of the NHS: From Creation to Reinvention, Oxford: Radcliffe Publishing.Google Scholar
Le Grand, J. (1999), ‘Competition, cooperation, or control? Tales from the British National Health Service’, Health Affairs, 18(3): 27–39.CrossRefGoogle ScholarPubMed
Le Grand, J., Mays, N.Mulligan, J. (eds) (1998), Learning From the NHS Internal Market, London: King’s Fund.Google Scholar
Light, D. W. (2008), ‘Will the NHS strategic plan benefit patients?’, British Medical Journal, 337: a824.CrossRefGoogle ScholarPubMed
Marshall, M. N., Shekelle, P. G., Leatherman, S.Brook, R. H. (2000), ‘The public release of performance data: what do we expect to gain? A review of the evidence’, Journal of the American Medical Association, 283(14): 1866–1874.CrossRefGoogle Scholar
Maynard, A. (1994), ‘Can competition enhance efficiency in health care? Lessons from the reform of the UK National Health Service’, Social Science & Medicine, 39(10): 1433–1445.CrossRefGoogle Scholar
Mays, N.Dixon, J. (1996), Purchaser Plurality in UK Health Care: Is a Consensus Emerging and is it the Right One?, London: King’s Fund.Google Scholar
Mays, N., Wyke, S., Malbon, G.Goodwin, N. (eds) (2001), The Purchasing of Health Care by Primary Care Organisations. An Evaluation and Guide to Future Policy, Buckingham: Open University Press.Google Scholar
Ministry of Welfare, Health and Cultural Affairs (1988), Changing Health Care in the Netherlands, The Hague: Ministry of Welfare, Health and Cultural Affairs.Google Scholar
OECD (2008), Health Data 2008, Paris: OECD (updated 10 December 2008).Google Scholar
Or, Z., Cases, C., Lisac, M., Vrangbæk, K., Winblad Spångberg, U.Bevan, G. (2010), ‘Are health problems systemic? Health reforms under Beveridgian and Bismarkian systems’, Health Economics, Policy and Law, 5: 269–293.CrossRefGoogle Scholar
Prinsze, F. J.Van Vliet, R. C. J. A. (2007), ‘Health-based risk adjustment: improving the pharmacy-based cost group model by adding diagnostic cost groups’, Inquiry, 44: 469–480.CrossRefGoogle ScholarPubMed
Propper, C., Burgess, S.Green, K. (2004), ‘Does competition between hospitals improve the quality of care?: hospital death rates and the NHS internal market’, Journal of Public Economics, 88(7–8): 1247–1272.CrossRefGoogle Scholar
Propper, C.Söderlund, N. (1998), ‘Competition in the NHS internal market: an overview of its effects on hospital prices and costs’, Health Economics, 7(3): 187–197.3.0.CO;2-F>CrossRefGoogle ScholarPubMed
Raftery, J., Robinson, R., Mulligan, J.-A.Forrest, S. (1996), ‘Contracting in the NHS Quasi-market’, Health Economics, 5(4): 353–362.3.0.CO;2-8>CrossRefGoogle ScholarPubMed
Schlesinger, M. J. (2010), ‘Choice cuts: parsing policymakers’ pursuit of patient empowerment from an individual perspective’, Health Economics, Policy and Law, 5: 365–387.CrossRefGoogle ScholarPubMed
Schut, F. T., Greenberg, W.van de Ven, W. P. M. M. (1991), ‘Antitrust Policy in the Dutch Health Care system and the Relevance of EEC Competition Policy and US antitrust Practice’, Health Policy, 17: 257–284.CrossRefGoogle ScholarPubMed
Schut, F. T.van de Ven, W. P. M. M. (2005), ‘Rationing and competition in the Dutch health care system’, Health Economics, 14: S59–S74.CrossRefGoogle ScholarPubMed
Secretaries of State for Health, Wales, Northern Ireland and Scotland (1989), Working for Patients Cm 555, London: HMSO.Google Scholar
Secretary of State for Health (1997), The New NHS Cm 3807, London: The Stationery Office.Google Scholar
Secretary of State for Health (2002), Delivering the NHS Plan Cm 5503, London: The Stationery Office, http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4005818&chk=zN/MoeGoogle Scholar
Shock, M. (1994), ‘Medicine at the centre of the nation’s affairs’, British Medical Journal, 309: 1730–1733.CrossRefGoogle ScholarPubMed
Starr, P. (1982), The Social Transformation of American Medicine, New York: Basic Books.Google Scholar
Street, A.Maynard, A. (2007), ‘Activity based financing in England: the need for continual refinement of payment by results’, Health Economics, Policy and Law, 2(4): 419–427.CrossRefGoogle ScholarPubMed
Tuohy, C. (1999), Accidental Logics. The Dynamics of Change in the Health Care Arena in the United States, Britain and Canada, New York: Oxford University Press.CrossRefGoogle Scholar
van de Ven, W. P. M. M., Beck, K., Van de Voorde, C., Wasem, J.Zmora, I. (2007), ‘Risk adjustment and risk selection in Europe: 6 years later’, Health Policy, 83(2): 162–179.CrossRefGoogle ScholarPubMed
van de Ven, W. P. M. M., Schut, F. T. (2007), Risk Equalisation in an Individual Health Insurance Market: the Only Escape from the Tradeoff Between Affordability, Efficiency and Selection, paper presented at the Workshop ‘The Structure of Health Plan Competition’ May 3–4, Stanford University, the “FRESH-thinking” project (see http://www.fresh-thinking.org/).Google Scholar
van de Ven, W. P. M. M.Schut, F. T. (2008), ‘Universal mandatory health insurance in the Netherlands: a model for the United States?’, Health Affairs, 27(3): 771–781.CrossRefGoogle Scholar
van de Ven, W. P. M. M.Schut, F. T. (2009), ‘Managed competition in the Netherlands: still work-in-progress’, Health Economics, 18: 253–255.CrossRefGoogle ScholarPubMed
van de Ven, W. P. M. M., Schut, F. T., Hermans, H. E. G. M., et al. (2009), Evaluatie Zorgverzekeringswet en Wet op de Zorgtoeslag, Den Haag: ZonMw, http://www.zonmw.nl/nl/publicaties/.Google Scholar
van de Ven, W. P. M. M., van Vliet, R. C. J. A.Lamers, L. M. (2004), ‘Health-adjusted premium subsidies in The Netherlands’, Health Affairs, 23(3): 45–55.CrossRefGoogle ScholarPubMed
Varkevisser, M., van der Geest, S.Schut, F. T. (2010), ‘Assessing hospital competition when prices don’t matter to patients: the use of time-elasticities’, International Journal of Health Care Finance and Economics, 10(1): 43–60.CrossRefGoogle Scholar
Welsh Assembly Government (2008), Proposals to Change the Structure of the NHS in Wales. Consultation Paper, Cardiff: Welsh Assembly Government, http://www.wlga.gov.uk/english/library/nhs-structure-consulation-document/.Google Scholar
Wilsford, D. (1994), ‘Path dependency, or why history makes it difficult but not impossible to reform health care systems in a big way’, Journal of Public Policy, 14(3): 251–283.CrossRefGoogle Scholar
Woods, K. J. (2001), ‘The development of integrated health care models in Scotland’, International Journal of Integrated Care, 1(1): 1–18. http://www.ijic.org/CrossRefGoogle ScholarPubMed
Wyke, S., Mays, N., Bevan, G., Goodwin, G., Malbon, G., McLeod, H.Street, A. (2003), ‘Should general practitioners purchase health care? The total purchasing experiment in Britain’, Health Policy, 65: 243–259.CrossRefGoogle ScholarPubMed