In this issue of 5 Questions with… we speak with Marco Varkevisser, Professor of Health Care Market Regulation at Erasmus School of Health Policy & Management (ESHPM). His work examines how healthcare markets can be designed in a way that keeps access broad, care high-quality, and the system financially sustainable.
Varkevisser is widely known for his research on health-insurance choice, competition between insurers, and the role of regulation in safeguarding solidarity. Through his collaborations with policymakers, insurers, and regulators, he works to translate economic insights into practical improvements for the Dutch healthcare system.
1. With Universal Health Coverage Day coming up on 12 December, why does this moment matter to you in the context of the Dutch health insurance system?
“In the Netherlands, universal access to health insurance and therefore to healthcare is guaranteed for everyone. That is something we should genuinely value. Too many low and middle income countries still lack that basic foundation. Universal Health Coverage Day is a moment to pause and reflect on this. Solidarity in healthcare is not automatic. It requires clear, consistent and decisive government regulation.”
2. You study how regulation and competition interact in our health insurance market. Are we striking the right balance here in the Netherlands?
“I believe we are. There is always room to improve, but the Dutch health system shows that regulated market forces can work together rather than against each other. You need both to safeguard accessibility, quality and financial sustainability.”
3. Your latest research looks at how Dutch consumers choose their health insurance. What do you hope to understand more clearly, and what could insurers or policymakers do to help people make more confident choices?
“Effective competition only works when people actually make choices. The way consumers decide to switch or not to switch insurers matters enormously. Together with Sara Arts, Tim Benning and other colleagues we want to better understand this decision making process. That knowledge can offer important insights for policymakers.
The key to helping people choose with confidence is transparency. People need clear information about what policies really offer. That means more than just the monthly premium. It also concerns contracted healthcare providers and the main agreements made with them. Without that clarity, confident decision making is difficult.”
4. Your research suggests that trust in health insurers is not as strong as it could be. How serious is that issue?
“It is a significant problem. Low trust makes people hesitant to switch insurers, which weakens competition in the market. It also makes insurers more cautious about taking on their role as decisive purchasers of care. That hesitancy undermines how the system is meant to function.”
5. Looking ahead, what kind of shift would you most like to see in the Dutch health insurance system, and what personally motivates you to keep working on these questions?
“I think the system is fundamentally robust and future proof. The core principles that support solidarity are not up for debate, which is reassuring. But insurers are at a crossroads. In short: will they take their role as powerful and decisive purchasers of care seriously, as originally intended, or will they leave the inevitable difficult choices to the healthcare sector and limit themselves to reimbursing claims? The answer to that question will shape the coming years.
As for motivation, healthcare is an economically fascinating field. As health economists David Dranove and Mark Satterthwaite wrote twenty five years ago, no other major market diverges so radically from the conditions of perfect competition. The challenge of combining market incentives and government intervention while ensuring access to high quality care and financial sustainability continues to drive my work.”
- Professor
