• Can universal access be achieved in a voluntary private health insurance market? Dutch private insurers caught between competing logics.

      Vonk, Robert A A; Schut, Frederik T (2018-05-07)
      For almost a century, the Netherlands was marked by a large market for voluntary private health insurance alongside state-regulated social health insurance. Throughout this period, private health insurers tried to safeguard their position within an expanding welfare state. From an institutional logics perspective, we analyze how private health insurers tried to reconcile the tension between a competitive insurance market pressuring for selective underwriting and actuarially fair premiums (the insurance logic), and an upcoming welfare state pressuring for universal access and socially fair premiums (the welfare state logic). Based on primary sources and the extant historiography, we distinguish six periods in which the balance between both logics changed significantly. We identify various strategies employed by private insurers to reconcile the competing logics. Some of these were temporarily successful, but required measures that were incompatible with the idea of free entrepreneurship and consumer choice. We conclude that universal access can only be achieved in a competitive individual private health insurance market if this market is effectively regulated and mandatory cross-subsidies are effectively enforced. The Dutch case demonstrates that achieving universal access in a competitive private health insurance market is institutionally complex and requires broad political and societal support.
    • The Dutch Public Health Foresight Study 2018: an example of a comprehensive foresight exercise.

      Verschuuren, Marieke; Hilderink, Henk B M; Vonk, Robert A A (2019-10-24)
    • Four normative perspectives on public health policy-making and their preferences for bodies of evidence.

      Schoemaker, Casper G; van Loon, Jeanne; Achterberg, Peter W; den Hertog, Frank R J; Hilderink, Henk; Melse, Johan; Vonk, Robert A A; van Oers, Hans (2020-08-24)
    • The Public Health Status and Foresight report 2014: Four normative perspectives on a healthier Netherlands in 2040.

      Schoemaker, Casper G; van Loon, Jeanne; Achterberg, Peter W; van den Berg, Matthijs; Harbers, Maartje M; den Hertog, Frank R J; Hilderink, Henk; Kommer, Geertjan; Melse, Johan; van Oers, Hans; et al. (2018-10-26)
      Policy-oriented foresight reports aim to inform and advise decision-makers. In value-laden areas such as public health and healthcare, deliberative scenario methods are clearly needed. For the sixth Dutch Public Health Status and Forecasts-report (PHSF-2014), a new approach of co-creation was developed aiming to incorporate different societal norms and values in the description of possible future developments. The major future trends in the Netherlands were used as a starting point for a deliberative dialogue with stakeholders to identify the most important societal challenges for public health and healthcare. Four societal challenges were identified: 1) To keep people healthy as long as possible and cure illness promptly, 2) To support vulnerable people and enable social participation, 3) To promote individual autonomy and freedom of choice, and 4) To keep health care affordable. Working with stakeholders, we expanded these societal challenges into four corresponding normative scenarios. In a survey the normative scenarios were found to be recognizable and sufficiently distinctive. We organized meetings with experts to explore how engagement and policy strategies in each scenario would affect the other three societal challenges. Possible synergies and trade-offs between the four scenarios were identified. Public health foresight based on a business-as-usual scenario and normative scenarios is clearly practicable. The process and the outcomes support and elucidate a wide range of strategic discussions in public health.