The impact of healthcare reform in the Netherlands.

In 1987, the Dekker committee proposed managed competition as the dominant principle for reforming healthcare in The Netherlands. Considerable progress has been made in implementing the Dekker proposal, such as risk-adjusted capitation of Sick Funds, yearly open enrollment and selective contracting with providers. The centre-right government, which came to power in 2003, plans to implement the final steps in the coming years, which will drastically change pharmaceutical policies and shift power from central government to regional actors in healthcare. The current price reference system, which was initiated in 1991, has failed in containing expenditure or providing incentives towards efficiency. For new drugs, which can not be clustered in the price reference system or for which the producer wants a premium price, a pharmacoeconomic study and budget impact analysis is formally required from 2005 onwards. This fourth hurdle may limit access to new drugs, which contribute considerably to expenditure or for which relative efficiency is above a certain cost-effectiveness threshold. In line with the Dekker principle, insurance companies are expected to step into the market and initiate policies to reduce costs. However, the government seems somewhat reluctant to abandon instruments belonging to old supply-side regulation. Given the current healthcare cost explosion, which coincides with an economic recession, it remains to be seen whether politicians will really shift the power to the insurers and not return to traditional cost-containment policies.