NIVEL (Netherlands institute for health services research), Otterstraat 118 - 124, 3513, CR Utrecht, The Netherlands.
BMC Health Serv Res. 2013 Oct 2;13:375. doi: 10.1186/1472-6963-13-375.
In a demand oriented health care system based on managed competition, health insurers have incentives to become prudent buyers of care on behalf of their enrolees. They are allowed to selectively contract care providers. This is supposed to stimulate competition between care providers and both increase the quality of care and contain costs in the health care system. However, health insurers are reluctant to implement selective contracting; they believe their enrolees will not accept this. One reason, insurers believe, is that enrolees do not trust their health insurer. However, this has never been studied. This paper aims to study the role played by enrolees' trust in the health insurer on their acceptance of selective contracting.
An online survey was conducted among 4,422 people insured through a large Dutch health insurance company. Trust in the health insurer, trust in the purchasing strategy of the health insurer and acceptance of selective contracting were measured using multiple item scales. A regression model was constructed to analyse the results.
Trust in the health insurer turned out to be an important prerequisite for the acceptance of selective contracting among their enrolees. The association of trust in the purchasing strategy of the health insurer with acceptance of selective contracting is stronger for older people than younger people. Furthermore, it was found that men and healthier people accepted selective contracting by their health insurer more readily. This was also true for younger people with a low level of trust in their health insurer.
This study provides insight into factors that influence people's acceptance of selective contracting by their health insurer. This may help health insurers to implement selective contracting in a way their enrolees will accept and, thus, help systems of managed competition to develop.
在以需求为导向的、基于管理竞争的医疗保健系统中，健康保险公司有激励代表其参保人成为谨慎的医疗保健购买者。他们被允许有选择地签订医疗服务提供方合同。这应该会刺激医疗服务提供方之间的竞争，提高医疗保健质量，并控制医疗保健系统的成本。然而，健康保险公司不愿意实施选择性合同；他们认为他们的参保人不会接受这一点。保险公司认为，原因之一是参保人不信任他们的健康保险公司。然而，这从未被研究过。本文旨在研究参保人对健康保险公司的信任在其对选择性合同的接受程度中所扮演的角色。
一项针对通过一家大型荷兰健康保险公司投保的 4422 人的在线调查。使用多项量表衡量对健康保险公司的信任、对健康保险公司购买策略的信任以及对选择性合同的接受程度。构建回归模型来分析结果。
对健康保险公司的信任被证明是参保人接受选择性合同的一个重要前提。对健康保险公司购买策略的信任与对选择性合同的接受程度之间的关联在老年人中比在年轻人中更强。此外，研究还发现，男性和更健康的人更容易接受他们的健康保险公司的选择性合同。对于对健康保险公司信任程度较低的年轻参保人来说，也是如此。
这项研究提供了影响人们对健康保险公司选择性合同接受程度的因素的见解。这可能有助于健康保险公司以参保人能够接受的方式实施选择性合同，从而帮助管理竞争系统的发展。
