Competition between healthcare insurers is hampering structural improvement of chronic care

Dutch healthcare insurers are potentially in a position to steer the path towards better-organized chronic care. At the moment, however, healthcare policy and the prevailing legislation are preventing insurers from being innovative in their procurement. Rules governing the free choice of specialist care and the competition between insurance companies are having a negative effect on the purchasing strategies of healthcare insurers.

These are the conclusions drawn by Bart Noort in his PhD thesis, after conducting a comparative study in England, Sweden and the Netherlands. Insurers occupy a difficult position, having to juggle the interests of care providers, citizens and government bodies. Dutch insurers in particular are increasingly inclined to fall back on their role as book-keepers and budget holders. Noort will be awarded a PhD by the University of Groningen on 17 September.

Competition

Politicians and policy makers expect the care procurement organizations (the health insurance companies in the Netherlands) to fulfil a directive role in healthcare. The idea is that contracts, financing and encouraging projects and innovation will enable procurers to deliver better care. This is particularly important for patients with a chronic illness, as the care needed by these patients generates greater leeway for cooperation between care providers such as GPs and clinical specialists. In this way, competition between healthcare insurers should lead to easily accessible, affordable, high-quality care.

Market forces hampering the structural embedding of care innovation

Noort shows that these market forces are actually hampering innovations in chronic care. He studied a case that revealed that — directed by a Dutch health insurer — it was both feasible and effective to implement home coaching for COPD patients. However, the conflicting interests and opinions of care providers and care procurement organizations are preventing promising outcomes from being afforded a structural place in regular care practices.

‘If improvements are to be made in a care chain, adequate agreements must be made in advance, with the right financial stimuli for all of the parties concerned and agreements about the current and future rights and obligations of those parties’, says Noort. His research shows that the current competition model is hampering any such agreements. ‘Government bodies and policy makers are obviously entitled to set standards for the organization and the quality of the care that is delivered, but they must also offer stimuli and conditions that will allow care chains to be organized according to best practices, such as this COPD initiative.’