Risk adjusted premium subsidies and risk sharing: key elements of the competitive sickness fund market in the Netherlands

Abstract

As part of a market-oriented health care reform, in 1991 risk adjusted premium subsidies were introduced in the Dutch social health insurance sector. Currently the premium subsidies are primarily based on demographic variables. To mitigate the obvious inadequacy of these risk adjusters, the system of risk adjustment is supplemented with a system of risk sharing. This paper describes the main characteristics of the Dutch health care system and the development of risk adjustment and risk sharing in the last decade. The effects of introducing financial risk for Dutch sickness funds on risk selection and consumer mobility are analysed. The paper concludes with a description of expected future developments.