The market-oriented health care reforms taking place in the Netherlands show a clear resemblance to the proposals for managed competition in U.S. health care. In both countries good risk adjustment mechanisms that prevent cream skimming--that is, that prevent plans from selecting the best health risks--are critical to the success of the reforms. In this paper we present an overview of the Dutch reforms and of our research concerning risk-adjusted capitation payments. Although we are optimistic about the technical possibilities for solving the problem of cream skimming, the implementation of good risk-adjusted capitation is a long-term challenge.

dx.doi.org/10.1377/hlthaff.13.5.120, hdl.handle.net/1765/58752
Health Affairs: the policy journal of the health sphere
Erasmus School of Health Policy & Management (ESHPM)

van de Ven, W.P.M.M, van Vliet, R.C.J.A, van Barneveld, E.M, & Lamers, L.M. (1994). Risk-adjusted capitation: Recent experiences in the Netherlands. Health Affairs: the policy journal of the health sphere (Vol. 13, pp. 120–136). doi:10.1377/hlthaff.13.5.120