Effects of the reform of the Dutch healthcare into managed competition: Results of a Delphi study among experts

Abstract

© 2020 The Authors. Background: In 2006 a major healthcare reform was introduced in the Netherlands, implying managedcompetition. This study explored the level of consensus on the outcomes and desired changes of this newsystem, and differences between stakeholder groups.Methods: A three-round Delphi-study was conducted among Dutch healthcare insurers, healtheconomists, and professionals in general practice (GP) care and mental health (MH) care. In the firstround, 20 experts indicated the most important advantages and disadvantages of the Dutch managedcompetition, and desired changes. Experts in the second (n = 106) and third round (N = 88) rated theimportance of the 88 factors identified in the first round.Results: Only healthcare insurers reached consensus on important advantages (i.e. improved efficiency;room for choice). Health economists reached almost no consensus on any factors. GP and MH-care profes-sionals reached most consensus on disadvantages (i.e. focus on price over quality, increased bureaucracy)and desired changes (i.e. reduce bargaining power of healthcare insurers; increase attention for care ofcomplex patients); half of them suggested abolishment of managed competition.Conclusion: GP and MH-care professionals were most dissatisfied and suggested several changes or evenabolishment of the 2006 reform; healthcare insurers mentioned some benefits. This level of dissatisfactionamong health care professionals indicates that there is room for improvement, preferably developed inconjunction with stakeholders.