C.J. Lako

An Experiment with Regulated Competition and Individual Mandates for Universal Health Care: The New Dutch Health Insurance System

The 2006 Enthoven-inspired Dutch health insurance reform, based on regulated competition with a mandate for individuals to purchase insurance, will interest U.S. policy makers who seek universal coverage. This ongoing experiment includes guaranteed issue, price competition for a standardized basic benefits package, community rating, sliding-scale income-based subsidies for patients, and risk equalization for insurers. Our assessment of the first two years is based on Dutch Central Bank statistics, national opinion polls, consumer surveys, and qualitative interviews with policy makers. The first lesson for the United States is that the new Dutch health insurance model may not control costs. To date, consumer premiums are increasing, and insurance companies report large losses on the basic policies. Second, regulated competition is unlikely to make voters/citizens happy; public satisfaction is not high, and perceived quality is down. Third, consumers may not behave as economic models predict, remaining responsive to price incentives. Finally, policy makers should not underestimate the opposition from health care providers who define their profession as more than simply a job. If regulated competition with individual mandates performs poorly in auspicious circumstances such as the Netherlands, how will this model fare in the United States, where access, quality, and cost challenges are even greater? Might the assumptions of economic theory not apply in the health sector?

Demand-Driven Care and Hospital Choice. Dutch Health Policy Toward Demand-Driven Care: Results from a Survey into Hospital Choice

In the Netherlands, current policy opinion emphasizes demand-driven health care. Central to this model is the view, advocated by some Dutch health policy makers, that patients should be encouraged to be aware of and make use of health quality and health outcomes information in making personal health care provider choices. The success of the new health care system in the Netherlands is premised on this being the case. After a literature review and description of the new Dutch health care system, the adequacy of this demand-driven health policy is tested. The data from a July 2005, self-administered questionnaire survey of 409 patients (response rate of 94%) as to how they choose a hospital are presented. Results indicate that most patients did not choose by actively employing available quality and outcome information. They were, rather, referred by their general practitioner. Hospital choice is highly related to the importance a patient attaches to his or her physician’s opinion about a hospital. Some patients indicated that their hospital choice was affected by the reputation of the hospital, by the distance they lived from the hospital, etc. but physician’s advice was, by far, the most important factor. Policy consequences are important; the assumptions underlying the demand-driven model of patient health provider choice are inadequate to explain the pattern of observed responses. An alternative, more adequate model is required, one that takes into account the patient’s confidence in physician referral and advice.

The management of confidentiality in general medical practice : a comparative study in the U.S.A. and the Netherlands

This paper describes the results of two studies in New Jersey and the eastern part of the Netherlands into the management of confidentiality among physicians in general medical practice. The physicians were presented with vignettes about confidentiality and were asked what course of action they would pursue. The results suggest that the physicians in New Jersey are less willing to disclose information without the patients consent to insurance physicians or occupational health physicians than their Dutch colleagues. However, in more conflicting situations the American physicians tend to favor more disclosure of information than their Dutch counterparts. Explanations of these differences include aspects of the legal system in New Jersey and the Netherlands.

Is Performance Measurement Applicable in the Public Sector? A Comparative Study of Attitudes among Dutch Officials

This article aims to study whether in the opinion of officials themselves, performance measurement can easily be applied in the public sector, and by what factors the differences in their views can be explained. Data from a survey of 26,876 civil servants were used. Among officials meeting certain criteria to be discussed, the majority are positive about the applicability of performance measurement. We conclude that supporters of the application of performance measures in their work are likely to see this as a tool that can be used to their own advantage, and which is in the interest of their organization.

Exploring the Job Demands–Resources Model of Work Engagement in Government: Bringing in a Psychological Perspective:

Work engagement refers to an active energetic state of mind that is characterized by vigor, dedication, and absorption. Despite practitioner’s attention for work engagement, few public administration scholars have studied public servants’ work engagement empirically. The goal of this study is to extend the job demands–resources (JD-R) model of work engagement using insights from the public administration literature. The analysis of a large-scale survey (N = 9,465) shows that (a) work and personal resources, including public service motivation, are positively related to work engagement; (b) red tape moderates these relationships; and (c) work engagement mediates the relationship between JD-R and job outcomes. In conclusion, public organizations can potentially increase work engagement and inherently employee outcomes by increasing work-related resources (autonomy, cooperation with colleagues) and selecting personnel with a proactive personality and high levels of public service motivation.

Proud to Be a Public Servant? An Analysis of the Work-Related Determinants of Professional Pride among Dutch Public Servants

ABSTRACT A proud public servant is defined as someone who works honorably, conscientiously, and with dedication. Although professional pride has several positive effects on the performances of public servants, it is not instantly apparent which instruments help to stimulate pride. This study combines the Job Demands-Resources model and the High Performance Work Practices taxonomy to analyze the determinants of pride. The analysis of a large dataset of Dutch public servants shows that their professional pride can barely be influenced by High-Performance Work Practices but is in particular determined by the work environment and personal experiences related to the work.