The Dutch health insurance law: the accumulation of 30 years of reform thought.

Background: The new health insurance law builds on a history of 30 years of reform plans and small steps, eventually leading to the recent reform. Methods: We use policy documents and papers from government, advisory bodies, and independent analysts to describe backgrounds of the reform and actual content of the new law. Results: Important characteristics of the content of the new insurance law are as follows: 1) no distinction between public and private insurance; one basic package; obligation to take insurance; 2) risk selection not allowed; 3) yearly possibility to change insurance; choice between benefits in kind or restitution and costsharing; 4) large nominal premium and income-related premium; 5) compensation for low-income groups; and collective offers with discounts. Conclusions: The insurance reform intends to give a more important role to insurance organizations and consumers. Possible unintended consequences are covert risk selection by insurance organizations, self-selection by the insured towards specific arrangements, an increase in uninsured people, and an overall increase in health care costs.(aut. ref.