tailieunhanh - THE SWISS AND DUTCH HEALTH INSURANCE SYSTEMS: UNIVERSAL COVERAGE AND REGULATED COMPETITIVE INSURANCE MARKETS

Private health insurance has offered a primary source of coverage for population groups ineligible to public programmes, and contributed to provide insurance protection against other public system coverage gaps. It has helped to inject resources into health systems, enabling an expansion in capacity and services. It also enhanced access to timely care in some systems experiencing prolonged public sector waiting times. However, all of these advantages have depended upon the structure and regulation of delivery systems, insurers’ strategic behaviours, the role that PHI plays, and regulation of public and private coverage. Furthermore, clear trade-offs have emerged. When resources and supply are scarce, it may be efficient to. | THE SWISS AND DUTCH HEALTH INSURANCE SYSTEMS UNIVERSAL COVERAGE AND REGULATED COMPETITIVE INSURANCE MARKETS Robert E. Leu Frans F. H. Rutten Werner Brouwer Pius Matter and Christian Rutschi January 2009 ABSTRACT As the United States resumes debate over options for achieving universal health coverage policymakers are once again examining insurance systems in other industrialized countries. More recent attention has focused on countries that combine universal coverage with private insurance and regulated market competition. Switzerland and the Netherlands in particular have drawn attention for their use of individual mandates combined with public oversight of insurance markets. This paper provides an overview of the Swiss and Dutch insurance systems which embody some of the same concepts that have guided health reforms adopted in Massachusetts and considered by other states and by federal policymakers. The two systems have many features in common an individual mandate standardized basic benefits a tightly regulated insurance market and funding schemes that make coverage affordable for low- and middle-income families. Differences include degree of centralization basis of competition among insurers availability of managed care and reliance on patient cost-sharing to influence care-seeking behavior. Support for this research was provided by The Commonwealth Fund. The views presented here are those of the authors and not necessarily those of The Commonwealth Fund or its directors officers or staff. This and other fund publications are available online at . To learn more about new publications when they become available visit the Fund s Web site and register to receive e-mail alerts. Commonwealth Fund pub. no. 1220. CONTENTS List of Figures and About the System Enforcement of Mandatory Health Basic Benefit Cost-Sharing by The Market for .