Citizen engagement in healthcare procurement decision-making by healthcare insurers: recent experiences in the Netherlands

Abstract

Background In insurance-based healthcare systems, healthcare insurers are interested in engaging citizens in care procurement to contract healthcare services that matter to people. In the Netherlands, an amendment to the Health Insurance Act was set forth in 2021 to formalize and strengthen the engagement of the insured population with healthcare insurers’ procurement cycles. This study explores the role of Dutch healthcare insurers in operationalizing citizen engagement in procurement cycles before changes occur linked to the amendment to the Health Insurance Act. Methods A phenomenological qualitative design was employed in two phases: (1) we consulted academics and policy experts on the role of healthcare insurers regarding citizen engagement; (2) we conducted focus groups with representatives of healthcare insurers to understand how citizens’ engagement is being operationalized. Transcripts of the interviews with experts and detailed notes of focus group meetings were analysed using a qualitative inductive approach. Selected excerpts were analysed on discourse and content and organized by a coding scheme following a rigorous and accelerated data reduction technique. Results We identified four strategies used by healthcare insurers to operationalize citizen engagement: (1) broadening their population health orientation; (2) developing and improving mechanisms for engaging citizens; (3) strengthening features of data governance for effective use of value-driven data; (4) implementing financial and incentive mechanisms among healthcare providers in support of value-based healthcare. However, regulated market mechanisms and low institutional trust in healthcare insurers undermine their transition from merely funding healthcare towards becoming people-centred value-based healthcare purchasers. Conclusion Dutch healthcare insurers seem to be strengthening the community orientation of their functioning while enhancing the end-to-end experience of the insured. The expected practical effects of the amendment to the Health Insurance Act include broadening the role of the council of insurees in decision-making processes and systematically documenting the efforts set forth by healthcare insurers in engaging citizens. Further research is needed to better understand how the regulated competitive market could be hampering the engagement of citizens in healthcare procurement decision-making and value creation from the citizens’ perspective.

Citizen engagement in national health insurance in rural western Kenya

“…Effective citizen engagement initiatives have been proven to be crucial for the success of health insurance systems as they increase awareness of insurance benefits and improve beneficiary satisfaction with the services ( Mcintyre, 2010 ; Ellen et al ., 2017a ; Brito Fernandes et al ., 2022 ). As low- and middle-income countries (LMICs) increasingly adopt social health insurance (SHI) programmes to increase population coverage and access to health services, evidence suggests that most schemes suffer growth challenges because of inadequate citizen engagement ( Odeyemi, 2014 ; Kotoh et al ., 2018 ).…”

Patienteneinbeziehung zur Förderung der Patientensicherheit

“…In Türkiye besteht ein Ziel der nationalen Patientensicherheitsstrategie in der Einbeziehung von Patient*innen und deren Angehörigen. Zur Orientierung wurden einige nationale Initiativen eingeleitet 33.…”

Patient engagement for patient safety

“…Embedding patients, families and carers, and communities voice in health policy is critical to drive the performance of healthcare systems and make them safer and more people-centred-and is also key for building agency, trust, a sense of ownership of the system, and foster co-production of health and accountability of other actors in the system, such as policy-makers and healthcare professionals (Brito Fernandes, 2022).…”

“…and carers, and communities" as it appears throughout the report. This choice of terminology aligns with the 2023 OECD Assessment of Policies to Engage Patients in Patient Safety Survey, which employs the notion of citizen to refer to the various roles associated with exercising citizenship and voice (Brito Fernandes, 2022). For instance, citizens may act as voters, taxpayers, active members of families, societal groups, or local communities, and in their broader participation in society, citizens may also receive care as patients or users of health care services, or assume the role of customers/clients seeking health-related products such as health insurance.…”