Acceptance of selective contracting: the role of trust in the health insurer

Abstract

BackgroundIn a demand oriented health care system based on managed competition, health insurers have incentives to become prudent buyers of care on behalf of their enrolees. They are allowed to selectively contract care providers. This is supposed to stimulate competition between care providers and both increase the quality of care and contain costs in the health care system. However, health insurers are reluctant to implement selective contracting; they believe their enrolees will not accept this. One reason, insurers believe, is that enrolees do not trust their health insurer. However, this has never been studied. This paper aims to study the role played by enrolees’ trust in the health insurer on their acceptance of selective contracting.MethodsAn online survey was conducted among 4,422 people insured through a large Dutch health insurance company. Trust in the health insurer, trust in the purchasing strategy of the health insurer and acceptance of selective contracting were measured using multiple item scales. A regression model was constructed to analyse the results.ResultsTrust in the health insurer turned out to be an important prerequisite for the acceptance of selective contracting among their enrolees. The association of trust in the purchasing strategy of the health insurer with acceptance of selective contracting is stronger for older people than younger people. Furthermore, it was found that men and healthier people accepted selective contracting by their health insurer more readily. This was also true for younger people with a low level of trust in their health insurer.ConclusionThis study provides insight into factors that influence people’s acceptance of selective contracting by their health insurer. This may help health insurers to implement selective contracting in a way their enrolees will accept and, thus, help systems of managed competition to develop.

Selective contracting by health insurers

“…We found nine studies that investigated ways to channel patients to preferred or contracted providers [11,[25][26][27][28][29][30][31][32][33]. Five of these were conducted in the Netherlands [11,[25][26][27]33].…”

“…Five of these were conducted in the Netherlands [11,[25][26][27]33]. The other studies were conducted in the US [28][29][30][31][32].…”

“…In other countries it was found that young and healthy enrolees more often choose restrictive health plans [27,34,35]. The reason for this may be that young people are more price sensitive and therefore focus more on the price of a health plan instead of having free care provider choice or a short travelling time [36,37]. People in poorer health are more at risk of having to change care providers, since they are more likely to already have an established relationship with a care provider.…”

“…Since the reform, selective contracting has become more important. It is allowed only in the 'preferred provider'-form, because European laws and regulations require health insurers to at least partially reimburse care that is not contracted [28]. In theory, health insurers are allowed to contract only a selection of care providers.…”

“…However, many enrolees were not aware the service existed. Furthermore, it is very important that the information comes from a trusted source [28]. Research from the Netherlands shows that enrolees are unwilling to accept advice from their health insurer about which care provider to choose [11,26].…”