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    Can universal access be achieved in a voluntary private health insurance market? Dutch private insurers caught between competing logics.

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    Authors
    Vonk, Robert A A
    Schut, Frederik T
    Type
    Article
    Language
    en
    
    Metadata
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    Title
    Can universal access be achieved in a voluntary private health insurance market? Dutch private insurers caught between competing logics.
    Published in
    Health Econ Policy Law 1029: 14(3):315-36
    Publiekssamenvatting
    For almost a century, the Netherlands was marked by a large market for voluntary private health insurance alongside state-regulated social health insurance. Throughout this period, private health insurers tried to safeguard their position within an expanding welfare state. From an institutional logics perspective, we analyze how private health insurers tried to reconcile the tension between a competitive insurance market pressuring for selective underwriting and actuarially fair premiums (the insurance logic), and an upcoming welfare state pressuring for universal access and socially fair premiums (the welfare state logic). Based on primary sources and the extant historiography, we distinguish six periods in which the balance between both logics changed significantly. We identify various strategies employed by private insurers to reconcile the competing logics. Some of these were temporarily successful, but required measures that were incompatible with the idea of free entrepreneurship and consumer choice. We conclude that universal access can only be achieved in a competitive individual private health insurance market if this market is effectively regulated and mandatory cross-subsidies are effectively enforced. The Dutch case demonstrates that achieving universal access in a competitive private health insurance market is institutionally complex and requires broad political and societal support.
    DOI
    10.1017/S1744133118000142
    PMID
    29732999
    URI
    http://hdl.handle.net/10029/621960
    ae974a485f413a2113503eed53cd6c53
    10.1017/S1744133118000142
    Scopus Count
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    Miscellaneous

    entitlement

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