Vulnerable Consumers in the Deregulated Dutch Health System


Public service deregulation is favoured for motivating providers to offer consumers better price-quality services. Consequently, consumers are enabled to make informed choices and choose for the best service provider. However, recent publications reveal that consumers are not capable of exercising optimal choice behaviour. Despite these concerns, evidence is lacking on the extent to which potentially vulnerable consumers make use of the core element of deregulation—switching health plans. This article is meant to study whether potentially vulnerable consumers do indeed switch less health plans in the deregulated Dutch health insurance market than regular consumers. In order to answer this question, we extract questionnaire data from the LISS panel, covering the years 2009-2012. A total of 16,779 health insurance consumers were included in the sample. The average response rate was 78%. Logistic regression results show that consumers being chronically ill, 60 and older, and without Internet access, do indeed switch less often. Intriguingly, non-working consumers and those living equal to or below the poverty line, turn out to switch more often than regular consumers. As a result, we conclude that the vulnerable consumer in the Dutch health insurance market is described by the following characteristics: chronically ill, 60 and older, and without Internet access. This specific group tends to get locked-in and suffers disproportion- ately from suboptimal choice behaviour.

Share and Cite:

Booltink, L. , van Genugten, M. and Lako, C. (2015) Vulnerable Consumers in the Deregulated Dutch Health System. Health, 7, 1061-1068. doi: 10.4236/health.2015.79120.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Clifton, J. and Díaz-Fuentes, D. (2010) Evaluating EU Policies on Public Services: Acitizens’ Perspective. Annals of Public and Cooperative Economics, 81, 281-311.
[2] Clifton, J., Díaz-Fuentes, D., Fernández-Gutiérrez, M. and Revuelta, J. (2011) Is Market-Oriented Reform Producing a “Two-Track” Europe? Evidence for Electricity and Telecommunications. Annals of Public and Cooperative Economics, 82, 495-513.
[3] Clifton, J., Díaz-Fuentes, D., Fernández-Gutiérrez, M., James, O., Jilke, S. and Van de Walle, S. (2012) Regulatory Reform for Services of General Interest and Trends in Citizen Satisfaction. COCOPS, Rotterdam.
[4] Grosso, A.L. and Van Ryzin, G.G. (2012) Public Management Reform and Citizen Perceptions of the UK Health System. International Review of Administrative Sciences, 78, 494-513.
[5] Florio, M. (2013) Network Industries and Social Welfare: The Experiment That Reshuffled European Utilities. Oxford University Press, Oxford.
[6] Jilke, S. (2015) Choice and Equality: Are Vulnerable Citizens Worse-Off after Liberalization Reform? Public Administration, 93, 68-85.
[7] European Commission (2004) EU Competition Policy and the Consumer. European Commission, Luxembourg.
[8] Jilke, S. (2013) Choice and Equality: Citizens’ Switching Behaviour in Liberalized Public Service Markets across the EU. COCOPS, Rotterdam.
[9] Schwartz, B. (2005) The Paradox of Choice: Why More Is Less. Harper Prennial, New York.
[10] Elbel, B. and Schlesinger, M. (2006) How Much Choice? Nonlinear Relationships between the Number of Plan Options and the Behavior of Medicare Beneficiaries. Yale University, New Haven.
[11] Frank, R.G. and Lamiraud, K. (2009) Choice, Price Competition and Complexity in Markets for Health Insurance. Journal of Economic Behavior and Organization, 71, 550-562.
[12] Burden, R. (1998) Vulnerable Consumer Groups: Quantification and Analysis. The Office for National Statistics, London.
[13] Hogg, M.K., Howells, G. and Milman, D. (2007) Consumers in the Knowledge-Based Economy (KBE): What Creates and/or Constitutes Consumer Vulnerability in the KBE? Journal of Consumer Policy, 30, 151-158.
[14] Clifton, J., Díaz-Fuentes, D. and Fernández-Gutiérrez, M. (2013) How Consumers’ Socio-Economic Background Influences Satisfaction: Insights for Better Utility Regulation. University of Cantabria, Cantabria.
[15] Andreasen, A.R. and Manning, J. (1990) The Dissatisfaction and Complaining Behaviour of Vul-nerable Consumers. Journal of Consumer Satisfaction, Dissatisfaction and Complaining Behaviour, 3, 12-20.
[16] OECD (2008) Enhancing Competition in Telecommunications: Protecting and Empowering Consumers. OECD, Paris.
[17] European Parliament (2012) European Parliament Resolution of 22 May 2012 on a Strategy for Strengthening the Rights of Vulnerable Consumers. European Parliament, Brussels.
[18] Eurostat (2000) European Social Statistics: Income, Poverty and Social Exclusion. Office for Official Publications of the European Communities, Luxembourg.
[19] OECD (2014) What Are Equivalence Scales? OECD, Paris.
[20] Vektis (2009) Verzekerdenmobiliteit en keuzegedrag 2009. Vektis, Zeist.
[21] Vektis (2011) Zorgthermometer: Verzekerden in beweging 2011. Vektis, Zeist.
[22] Vektis (2012) Zorgthermometer: Verzekerden in beweging 2012. Vektis, Zeist.
[23] van Kleef, R., Schut, E. and van de Ven, W. (2014) Evaluatie zorgstelsel en risicoverevening: Acht jaar na invoering Zorgverzekeringswet: Succes verzekerd? Erasmus University Rotterdam, Rotterdam.
[24] Bes, R., Brabers, A., Wendel, S., Reitsma-Van Rooijen, M., Bouwhuis, S. and de Jong, J. (2012) Alleen wisselen voor de aanvullende zorgverzekering? Niet bij alle zorgverzekeraars mogelijk! NIVEL, Utrecht.
[25] Duijmelinck, D. and van de Ven, W.P.M.M. (2011) Beperking keuzevrijheid zorgpolis door aanvullende verzekering. Economische Statistische Berichten, 96, 634-637.
[26] Duijmelinck, D. and van de Ven, W.P.M.M. (2015) Switching Rates in Health Insurance Markets Decrease with Age: Empirical Evidence and Policy Implications from the Netherlands. Health Economics, Policy and Law, Available on CJO2015.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.