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Perspective
Volume 357:2421-2423 December 13, 2007 Number 24
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Going Dutch — Managed-Competition Health Insurance in the Netherlands
Alain C. Enthoven, Ph.D., and Wynand P.M.M. van de Ven, Ph.D.

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Twenty-five years ago, the health care system of the Netherlands was operating under top-down cost-containment policies, such as regulation of doctors' fees and hospital budgets, that were widely criticized for lacking incentives for efficiency and innovation. In 1986, the Dekker Committee, an independent group appointed by the Dutch government to seek a solution, recommended market-oriented reform within the context of a national health insurance system. But before the concept could be implemented, a host of adequate systems had to be developed — systems of risk equalization, of product classification and medical pricing to give providers appropriate incentives for efficiency, of . . . [Full Text of this Article]


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Dr. Enthoven is a professor of management at the Stanford University Graduate School of Business, Stanford, CA. Dr. van de Ven is a professor of health insurance in the Department of Health Policy and Management, Erasmus University, Rotterdam, the Netherlands.


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