Quality and efficiency improvement and cost containment through regulated competition in the Dutch health care system

In 2006 the Netherlands commenced a major reform of its health care system. The main elements of the reform were: 1) replacement of the existing system of social health insurance for people with below average income and private health insurance for people with above average income by a universal private health insurance with the identical entitlements and contributions for all 2) the gradual introduction of elements of managed competition in hospital markets. The main aims of the reforms were to improve the so-called “public interests” in health care which were defined as quality, access, efficiency and cost containment in health care. This paper describes the reforms that have been enacted in the Dutch health care system and evaluates the impact of these reforms on the “public interests” in health care. The health care reforms have had positive effects on most of “public interests”, though still much needs to be done e.g. development of quality standards, curbing the rapid rising costs of health care. Nevertheless, the reforms are still a work in progress, and there is still a great deal of  room for further improvement in ‘public interest’ in the Dutch health care system.