Health financing for universal coverage

The new Dutch health insurance scheme: challenges and opportunities for better performance in health financing

Discussion paper 3/2007


World Health Organization

Publication details

Number of pages: 41
Publication date: 2007
Languages: English
WHO reference number: HSS/HSF/DP.07.3



This paper describes the 2006 reforms in the Dutch health financing scheme, documenting a systemic shift from supply- to demand-side control. The new model is referred to as regulated competition, implying enhanced competition between insurers and providers, but within the boundaries of a legal framework. Most health system functions, apart from stewardship, are devolved to private entities. In 2006, the model was implemented only in a limited part of the health care market. If successful, it may be extended to other segments as well.

This paper analyzes the reforms in view of the health system goals. These include improved health, fairness of financial contribution and responsiveness. The analysis is based on the WHO health financing framework, which applies a number of key performance indicators to the scheme. The new Dutch model is found to provide opportunities for the achievement of the health system goals and to increase efficiency. On most indicators it produces improvements compared to the previous scheme.

However, the new model does not give guarantees for high quality performance; it rather brings additional risks of market failure that require constant monitoring and may result in higher transaction and administrative costs than the previous scheme. The paper concludes with a brief discussion about the feasibility of the model for other countries.