A Four Modes Approach to Ration Health Care
A four modes approach to ration health care
Typically, modern health care systems are faced with the presence of conflicting policy goals, like managing the increasing health care costs and providing equal access to the health care that is needed (Cutler 2002). Therefore, the Dutch health care system moved over time from an etatist policy program to a market-oriented program. A process called rationing of health care is often applied to maintain health care costs. To date, health insurance is governed by the market, not the state. This modification of the health care system simultaneously changed the role of the health insurer (Zorgverzekeringswet, 2006). They are responsible for providing their clients good quality health care for the lowest price. This is arranged in a process called “zorginkoop” (to buy health care), which leads to selective contracting of health care providers. Price, quality, amount, and type of health care are described in these contracts (RVZ 2008:7). As a consequence, some health care providers are contracted by the health insurer and some not.
Multiple conflicting interests are present in this case. The NZa promotes selective contracting of health care providers based on transparent quality criteria, keeping the health care providers conscious about price and quality (Stafleu van Loghum, 2011). However, health care providers doubt that this will lead to higher quality of care since these quality criteria are insufficiently scientifically proven. A second doubt is the quality of the used data (Stafleu van Loghum, 2011). Furthermore, patients and patient groups are concerned about the access of health care and freedom of choice.
According to Streeck and Schmitter (1985), the Community, the Market, and the State are the three models of social order that have dominated in social science. All three have their specific conflicts. Applicable to the case above are the conflict in economic markets. Namely, the conflict of sellers and
Typically, modern health care systems are faced with the presence of conflicting policy goals, like managing the increasing health care costs and providing equal access to the health care that is needed (Cutler 2002). Therefore, the Dutch health care system moved over time from an etatist policy program to a market-oriented program. A process called rationing of health care is often applied to maintain health care costs. To date, health insurance is governed by the market, not the state. This modification of the health care system simultaneously changed the role of the health insurer (Zorgverzekeringswet, 2006). They are responsible for providing their clients good quality health care for the lowest price. This is arranged in a process called “zorginkoop” (to buy health care), which leads to selective contracting of health care providers. Price, quality, amount, and type of health care are described in these contracts (RVZ 2008:7). As a consequence, some health care providers are contracted by the health insurer and some not.
Multiple conflicting interests are present in this case. The NZa promotes selective contracting of health care providers based on transparent quality criteria, keeping the health care providers conscious about price and quality (Stafleu van Loghum, 2011). However, health care providers doubt that this will lead to higher quality of care since these quality criteria are insufficiently scientifically proven. A second doubt is the quality of the used data (Stafleu van Loghum, 2011). Furthermore, patients and patient groups are concerned about the access of health care and freedom of choice.
According to Streeck and Schmitter (1985), the Community, the Market, and the State are the three models of social order that have dominated in social science. All three have their specific conflicts. Applicable to the case above are the conflict in economic markets. Namely, the conflict of sellers and
References: Cutler, D. M. 2002. Equality, Efficiency, and Market Fundamentals: The Dynamics of International Medical-Care Reform. Journal of Economic Literature, 40: 881–906. Raad voor de Volksgezondheid en Zorg. 2008. Zorginkoop. Den Haag, 2008. Schut, F. T. 1995. Health Care Reform in the Netherlands: Balancing Corporatism, Etatism, and Market Mechanisms. Journal of Health Politics, Policy and Law, 20: 615–652. Stafleu van Loghum, B. 2011. NZa wijst klacht over selectieve inkoop CZ af, Zorg en Financiering, 10(8): 40 – 41. Streeck, W. Schmitter, P.C. 1985. Community, Market, State – and Associations?: The prospective Contribution of Interest Governance to Social Order. European Sociological Review. 1 (2): 119-139. Tenbensel, T. 2005. Multiple Moded of Governance: Disentangling the alternatives to hierarchies and markets. Public Management Review. 7(2): 267-288.