More and more countries rely on risk equalization to compensate competing health insurers for predictable variation in healthcare expenses between healthy individuals and the chronically ill. Recent studies have shown that even the most sophisticated risk equalization models undercompensate for several groups of people in poor health. Inadequate risk equalization is a potential threat to the accessibility of (good-quality) healthcare since insurers may charge high premiums to groups that are undercompensated or – if premium differentiation is not possible/allowed – insurers have incentives for risk selection. Our research focusses on the evaluation and improvement of risk equalization models. With international colleagues we have founded the “Risk Adjustment Network” in order to endorse an international exchange of scientific results in this field and to enhance the usability of these results in the political process.
Richard van Kleef (contact person) Tel: 0104088950 firstname.lastname@example.org René van Vliet Tel: 0104088585 email@example.com Wynand van de Ven Tel: 0104088556 firstname.lastname@example.org Frank Eijkenaar Tel: 0104089183 email@example.com Danielle Cattel
firstname.lastname@example.org Erik Schut Tel: 0104088558 email@example.com Anja Withagen-Koster Tel: 0104088778 firstname.lastname@example.org Mieke Reuser email@example.com
A key feature of the Dutch healthcare reforms is that competing health insurers are responsible for the purchasing of healthcare services. Insurers will increasingly be enabled to freely negotiate with providers about price, volume, and performance, with the aim of stimulating providers to improve quality and reduce costs. In this regard the department focuses on important questions, including: which incentives and tools do insurers have to actively fulfill their role as prudent purchaser of care on behalf of their enrollees? To what extent are insurers actually taking up this new role? What obstacles can be identified that hamper insurers from fulfilling their purchasing role, and how can these obstacles be effectively removed? In answering these questions, the department takes into account experiences from other countries, including the United States, The United Kingdom, Germany, and Switzerland.
Erik Schut (contact person)
firstname.lastname@example.org Marco Varkevisser Tel: 0104089105 email@example.com
Wynand van de Ven
Frank Eijkenaar Tel: 0104089183 firstname.lastname@example.org
Health insurance schemes worldwide include several forms of cost sharing such as deductibles, coinsurance and copayments. On the one hand cost sharing may enhance efficiency by reducing moral hazard. On the other hand, however, it may reduce solidarity since the elderly and chronically ill may incur higher out-of-pocket expenses than the young and healthy. Our research focusses on the design and effects of cost sharing. An important goal is to develop innovative forms of cost sharing that are both more effective in reducing moral hazard and improve solidarity.
Richard van Kleef (contact person)
René van Vliet
Wynand van de Ven
In many countries reform of prevailing payment systems for healthcare providers is high on the agenda. Policymakers and purchasers are increasingly looking for ways to create incentives for a more efficient delivery of healthcare services through the use of alternative payment approaches. In this respect the focus is not only on discouraging needless use of (expensive) care, but increasingly also on incentivizing improvements in the quality of care, including health outcomes. The department studies international experiences with innovative payment methods (e.g. pay-for-performance), including effects on quality, accessibility, and costs. In addition, the department focuses on providing insight in crucial conceptual and practical issues in the design and implementation of payment methods. For example, how to take into account systematic differences in providers’ patient populations (casemix)? How can unintended consequences be effectively prevented? And how to adequately measure and reward providers’ performance regarding quality of care and costs?
Frank Eijkenaar (contact person)
In many countries healthcare reforms are taking place aiming at improving efficiency and affordability of healthcare. Often these reforms imply (elements of) regulated competition, i.e. competition among health insurers and among care providers regulated by government in order to achieve the public goals (e.g. affordability and efficiency of care). Realizing these public goals implies that certain preconditions must be fulfilled. Our research focuses not only on the Netherlands, but also on e.g. Belgium, China, Germany, Ireland, Israel en Switzerland. International comparisons result in interesting lessons and important new insights.
Wynand van de Ven (contact person)
Consumer choice is one of the essential preconditions for regulated competition in health care. The ease to switch health insurance is important for an efficient and user-friendly insurer’s service. Consumers’ perceptions about freedom to take out health insurance play a big role. Only if consumers are able to ‘vote with their feet’ will insurers actively purchase healthcare products that fulfill the needs of their enrollees.
This research area investigates the consumer behavior on the insurance market. Specifically, which subgroups of the population switch and which determinants cause the switching behavior. Devising effective solutions to reduce or eliminate switching barriers is essential to improve the performance of the Dutch healthcare system.
Stéphanie van der Geest (contact person)
Marco Varksevisser Tel: 0104089105 email@example.com Timo Lambregts Tel: 0104088823 firstname.lastname@example.org
Wynand van de Ven
Richard van Kleef
Erik Schut Tel: 0104088558 email@example.com
An unregulated market in the health care sector leads to suboptimal outcomes due to the specific nature of health care. Therefore, a system of regulated competition has been implemented. On the one hand, some government regulation is necessary to protect the public interests of quality, accessibility and affordability. On the other hand, competition helps improve efficiency. In addition, an active competition policy is required to ensure fair competition. Important research question are: To what extent is government regulation necessary? Which forms of competition are socially desirable? And does the health care sector require a specific competition policy?
Marco Varkevisser (contact person)
Anne-Fleur Roos Tel: 0104088941
Stéphanie van der Geest
Wouter van der Schors
The Dutch mental healthcare sector underwent an important change in 2008. Most of mental healthcare services – both primary and secondary – were transferred to the basic health insurance scheme (ZVW). This reform triggered several effects such as increased overall expenditure, a greater number of (self-employed) providers, and innovation. The role of health insurers became much stronger in this sector. Budgets were replaced with an output-based payment system that implies negotiations between insurers and providers on price per service. Regulated competition was introduced in mental healthcare. This research area draws upon the effects of this policy change on public goals such as affordability, accessibility, and quality of mental health. We seek to examine a diverse range of issues and trends that impact this sector.
Rudy Douven (contact person)
Timo Lambregts Tel: 0104088823 firstname.lastname@example.org
Worldwide the organization and financing of long-term care (LTC) is facing serious challenges due to the ageing of societies. Ensuring financial and fiscal sustainability of LTC systems is indicated as the most important policy priority by policy makers within the OECD (OECD, Help Wanted?, 2011). A major research question therefore is how to design a sustainable, accessible, efficient and equitable LTC system.
Erik Schut (contact person)