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.

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Health Affairs: the policy journal of the health sphere
Erasmus MC: University Medical Center Rotterdam

van de Ven, W., van Barneveld, E., Lamers, L., & van Vliet, R. (1994). Risk-adjusted capitation: recent experiences in The Netherlands. Health Affairs: the policy journal of the health sphere. Retrieved from