Chapter 2

CEIS Health Report 2006
2.5.3 Shifting responsibility away from the government
The reform can be seen as a shift of power away from the government to the health insurers,
health care providers and patients. The most important tasks of the government
remain the definition of the basic package and the control of the quality of care and the
functioning of the markets. Regarding finance total expenditure is about € 50 billion or
about 10% of GDP divided in equal shares between curative care and long term care. In
the first sector the contribution of the government is limited to paying for the insurance
for children for which the insured pay no premium (6% of total expenditure or € 1,9 billion).
Regarding long term care the government’s contribution is 19% of total expenditure
or € 4,7 billion. The patients themselves pay an additional € 1,8 billion, which is 7%
of total expenditure for long term care. The bulk of the money for both sectors comes
from insurance premiums either paid into a central fund or paid directly to the health insurers.
The responsibility for cost control therefore lies with the private sector and the role
of the government in public spending has become more limited. Unlike in Italy the health
sector can not produce a large deficit as premiums are set in such a way as to cover most
of the costs of the system.
2.5.4 Conclusion
The implementation of regulated competition on this scale presents great challenges to
all parties involved. For example, how should the conditions for effective competition in
health care be defined and what regulatory policies are necessary to promote them?
Concepts and instruments used for this purpose in traditionally commercial sectors will
have to be adapted for use in the health care sector. Furthermore, the stewardship of a
well informed, capable and dedicated government will be required. Therefore, some time
will pass before the fruits of competition in health care can be harvested.
References
● Committee Structure and Finance of Health Care. “Preparing for change”. The Hague:
DOP, 1987.
● Enthoven AC. “Health Plan; the only solution to the soaring cost of medical care”.
Addison Wesley Pub Co, Reading, 1980.
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