Show simple item record

dc.contributor.authorVonk, Robert A A
dc.contributor.authorSchut, Frederik T
dc.date.accessioned2018-05-27T13:20:41Z
dc.date.available2018-05-27T13:20:41Z
dc.date.issued2018-05-07
dc.identifier.citationCan universal access be achieved in a voluntary private health insurance market? Dutch private insurers caught between competing logics. 2018:1-22 Health Econ Policy Lawen
dc.identifier.issn1744-134X
dc.identifier.pmid29732999
dc.identifier.doi10.1017/S1744133118000142
dc.identifier.urihttp://hdl.handle.net/10029/621960
dc.description.abstractFor 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.
dc.language.isoenen
dc.rightsArchived with thanks to Health economics, policy, and lawen
dc.titleCan universal access be achieved in a voluntary private health insurance market? Dutch private insurers caught between competing logics.en
dc.typeArticleen
dc.identifier.journalHealth Econ Policy Law 1029: 14(3):315-36en
html.description.abstractFor 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.


This item appears in the following Collection(s)

Show simple item record