Consumer choice in the Dutch health insurance market.

Background: In the last decades, health care reforms based on introducing managed competition have been implemented in several countries. The policy assumption is that managed competition leads to lower prices and increases the quality of health care. However, not much is known about the underlying assumptions. The assumption of the critical health care consumer is a crucial one. The mechanism for improving quality and, at the same time, lowering costs is based on this assumption. Besides these assumptions on choosing there is another, underlying assumption: it is assumed that consumers want choice in health care. This study focuses on this assumption. Does it hold, and if so, does it apply to all socio-demographic groups? In addition we studied whether people perceive enhanced choice. Methods: Questionnaires were sent to the Dutch Health Care Consumer Panel, a cross-section of the Dutch population. Data were collected from 2005 until 2008 from approximately 1000 panel members per year. Results: The study shows that overall people think it is important to have enhanced choice in health care. Choices between insurers and between providers are approximately of equal importance to people. Comparing different providers, people attach more importance to enhanced choice between medical specialists and hospitals than to enhanced choice between general practitioners. This holds for all socio-demographic groups, although these groups differ in the extent to which they prefer enhanced choice. Conclusions: The results of the study suggest that the preference for enhanced choice depends on the extent to which people are confronted with choices. In order to facilitate choice, decisionmaking-assistance should be targeted at those people, for example the elderly, who are frequently confronted with choices on high risk procedures. (aut. ref.