Allokative und distributive Effekte regulierten Wettbewerbs in sozialen Krankenversicherungssystemen Wirtschaftstheoretische Fundierung, tatsächliche Auswirkungen und Implementationsprobleme am Beispiel der Niederlande

The concept of managed competition in health care attracts a lot of attention from policy makers not only in Germany but from countries all around the world. The aim of this concept is to increase the efficiency of health care systems as well as maintaining solidarity. Since the health care system of the Netherlands is institutionally and culturally quite similar to the German system it is promising to test the behavioral assumptions of the model and to draw conclusions for Germany. Furthermore this work tries to analyze several economic theories of competition with regard to the functions and aims of competition.The results of the research show that the spirit of competition in the Dutch health care system is quite underdeveloped. Consumers do switch sickness funds, although to a much lesser extent than expectet. Instead of competing with each other, insurers try to retain regional monopolies. There is no selective contracting between insurers and providers of care. Effects on solidarity also are very limited, although the exclusion of dental services from the basic insurance packet seems to have negative effects on the access to health care for lower income groups. The reasons for the low degree of intensity of competition are twofold. First, there are serious theoretical deficiencies of the managed competition model. Second, the incentives and instruments for competition in the Dutch system diverge to a significant degree from the ideal model of managed competion while market actors at the same time do not find it rewarding to use the incentives and instrument they have access to. Consequently, policy makers have to face considerable challenges if they try to implement managed competition model in Germany