Vulnerable Consumers in the Deregulated Dutch Health System

Abstract

Public service deregulation is favoured for motivating providers to offer consumers better pricequality services. Consequently, consumers are enabled to make informed choices and choose for the best service provider. However, recent publications reveal that consumers are not capable of exercising optimal choice behaviour. Despite these concerns, evidence is lacking on the extent to which potentially vulnerable consumers make use of the core element of deregulation-switching health plans. This article is meant to study whether potentially vulnerable consumers do indeed switch less health plans in the deregulated Dutch health insurance market than regular consumers. In order to answer this question, we extract questionnaire data from the LISS panel, covering the years 2009-2012. A total of 16,779 health insurance consumers were included in the sample. The average response rate was 78%. Logistic regression results show that consumers being chronically ill, 60 and older, and without Internet access, do indeed switch less often. Intriguingly, nonworking consumers and those living equal to or below the poverty line, turn out to switch more often than regular consumers. As a result, we conclude that the vulnerable consumer in the Dutch health insurance market is described by the following characteristics: chronically ill, 60 and older, and without Internet access. This specific group tends to get locked-in and suffers disproportionately from suboptimal choice behaviour.

The Vexed Question of Market Stewardship in the Public Sector: Examining Equity and the Social Contract through the Australian National Disability Insurance Scheme

“…Research suggests that vulnerable citizens are less likely to reap the benefits of market‐based service reforms (Anttonen ; Booltink et al . ; Botti and Iyengar ; Dan and Andrews ; Jilke ). Jilke (), for example, found that socio‐economic position is a significant determinant of the quality of services citizens will receive and their ability to switch from unsatisfactory providers.…”

“…Our data supports this ambiguity; the system for identifying and addressing emerging issues is currently informal and unfixed in the NDIS implementation; however, this will be more formalized when the proposed Quality and Safeguards Framework has been finalized. Research suggests that vulnerable citizens are less likely to reap the benefits of market-based service reforms (Anttonen 2012;Booltink et al 2015;Botti and Iyengar 2006;Dan and Andrews 2016;Jilke 2015). Jilke (2015), for example, found that socioeconomic position is a significant determinant of the quality of services citizens will receive and their ability to switch from unsatisfactory providers.…”

“…It is important to note that 'diversity' and 'choice' raise questions regarding choice for whom and on what basis. Research has shown that vulnerable people can still end up in tutelage relationships with the state within market approachesunable to truly exercise choice and control (Booltink et al 2015;Carey and Crammond 2014;Jilke 2015;Williams 1992). As figure 1 outlines, this is more likely to occur where governments take up regulatory roles, but shy away from market stewardship.…”