Health insurance and switching behavior: Evidence from the Netherlands

Ferdy van Beest, Christiaan Lako, Esther-Mirjam Sent

Nyenrode Business University, Breukelen, The Netherlands.
Radboud University Nijmegen, Nijmegen, The Netherlands.

DOI: 10.4236/health.2012.410125                

Abstract

Introduction: Since the introduction of the Health Insurance Act in the Netherlands in 2006, insurers are incentivized to compete on prices for basic health insurance, and on price and quality for supplementary insurance. The new health insurance system aimed to create a more competitive market in which consumers would switch health plans, thereby stimulating insurers to price competition and quality improvement. This article evaluates the switching behavior of Dutch consumers and evaluates whether this behavior is advantageous to the goals of the reform. Methods: Three surveys were conducted: from 2005-2006 (n = 478), 2008-2009 (n = 389), and 2010-2011 (n = 191). Results: In 2005-2006, almost 20 percent of the Dutch consumers switched their insurance company. In between 2006 and 2012, however, the percentage of switchers decreased to less than four percent. The main cause of this decrease is that consumers no longer perceive sufficient differences between insurance companies in terms of premium and service. In addition, consumers have difficulties finding the proper information making the right decision and believe they may not be accepted for the supplementary insurance. Consequently, insurance companies only perceive limited incentives to create a more competitive market. Conclusion: Clear and unambiguous information, combined with an obligatory acceptance for the supplementary insurance might help to improve the potential mobility of Dutch consumers.

Keywords

Health Insurance; Switching; Survey

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	[1] Rosenau, P. and Lako C.J. (2008) An experiment with regulated competition and individual mandates for universal health care: The new Dutch health insurance system. Journal of Health Politics, Policy and Law, 33, 1031-1055. doi:10.1215/03616878-2008-033
[2]	Roos, A.F., and Schut, F.T. (2012) Spillover effects of supplementary on basic health insurance: Evidence from the Netherlands. European Journal of Health Economics, 13, 51-62. doi:10.1007/s10198-010-0279-6
[3]	Vektis (2009) Verzekerdenmobiliteit en Keuzegedrag 2009. Vektis, Zeist.
[4]	Maarse, H. (2011) Markthervorming in de zorg. Maastricht University, Maastricht.
[5]	Okma, K.G.H. and Crivelli, L. (2010) Six countries, six reform models: The healthcare reform experience of Israel, The Netherlands, New Zealand, Singapore, Switzerland and Taiwan: Healthcare reforms “under the radar screen”. World Scientific Publishing, Hackensack.
[6]	Balogh, R. and van Veen-Dirks, P. (2010) Marktwerking in de zorg: Budgettering in roerige tijden. Maanblad voor Accountancy en Bedrijfseconomie, 10, 493-505.
[7]	Hendriks, M., de Jong, J., van Brink-Muinen, A. and Groenewegen, P. (2010) The intention to switch health insurer and actual switching behaviour: Are there differences between groups of people? Health Expectations, 13, 195-207. doi:10.1111/j.1369-7625.2009.00583.x
[8]	Buchmueller, T.C. and Feldstein, P.J. (1997) The effect of price on switching among health plans. Journal of Health Economics, 16, 231-247. doi:10.1016/S0167-6296(96)00531-0
[9]	Van Beest, F., Lako, C., Vyrastekova J. and Sent E.M. (2008) Veranderen van zorgverzekeraar. Economisch Statistische Berichten, 93, 518-521
[10]	Van de Ven, W.P.M.M. and Schut, F.T. (2009) Managed competition in the Netherlands: Still work-in-progress. Health Economics, 18, 253-255. doi:10.1002/hec.1446
[11]	Ng, J., Kasper, J., Forrest, C. and Bierman, A. (2007) Predictors of voluntary disenrollment from medicare managed care. Medical Care, 45, 513-520. doi:10.1097/MLR.0b013e31802f91a5
[12]	Risker, C. (2000) Factors influencing employee health plan choice in the corporate Setting. Health Marketing Quarterly, 18, 15-27. doi:10.1300/J026v18n01_02
[13]	Anderson, C. (2003) The psychology of doing nothing: Forms of decision avoidance result from reason and emotion. Psychological Bulletin, 129, 139-166. doi:10.1037/0033-2909.129.1.139
[14]	Dormont, B., Geoffard, P.-Y., Lamiraud, K. (2009) The influence of supplementary health insurance on switching behaviour: Evidence from Swiss data. Health Economics, 18, 1339-1356. doi:10.1002/hec.1441
[15]	Beaulieu, N.D. (2002) Quality information and consumer health plan choices. Health Economics, 21, 43-63. doi:10.1016/S0167-6296(01)00126-6
[16]	Schwartz, B. (2004) De paradox van keuzes: Hoe teveel een probleem kan zijn. Spectrum,
[17]	Abraham, J. M., Feldman R., Carlin C., and Christianson J. (2006) The effect of quality Information on consumer health plan switching: Evidence from the Buyers Health Care Action Group. Journal of Health Economics, 25, 762-781. doi:10.1016/j.jhealeco.2005.11.004
[18]	Hurenkamp, M. and Kremer M. (2005) Vrijheid verplicht. Over tevredenheid en de grenzen van keuzevrijheid. Van Gennep, Amsterdam.
[19]	Kerssens, J.J., Delnoij, D.M.J., Verweij, J.A. and van der Schee, E. (2002) De keuze van ziekenfondsverzekerden voor een zorgverzekeraar. TSG Gezondheidswetenschappen, 80, 35-42.
[20]	CBS. 14 april (2008) Web Magazine.
[21]	Atos Consulting (2007) Mobiliteit in zorgverzekeringsmarkt neemt sterk af. Atos Consulting, Utrecht.
[22]	Poiesz, T. and van Raaij, W.F. (2008) Strategic marketing and the future of consumer behaviour: Introducing the virtual guardian angel. Edward Elgar, Cheltenham.
[23]	Rosenau, P. and Lako, C.J. (2008) Health insurance experiments in the Netherlands and Switzerland: A rejoinder with updates. Journal of Health Politics, Policy and Law, 33, 1073-1077. doi:10.1215/03616878-2008-037