Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands.
Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands.
Health Policy. 2021 Jan;125(1):27-33. doi: 10.1016/j.healthpol.2020.10.010. Epub 2020 Nov 7.
In 2006 a major healthcare reform was introduced in the Netherlands, implying managed competition. This study explored the level of consensus on the outcomes and desired changes of this new system, and differences between stakeholder groups.
A three-round Delphi-study was conducted among Dutch healthcare insurers, health economists, and professionals in general practice (GP) care and mental health (MH) care. In the first round, 20 experts indicated the most important advantages and disadvantages of the Dutch managed competition, and desired changes. Experts in the second (n = 106) and third round (N = 88) rated the importance of the 88 factors identified in the first round.
Only healthcare insurers reached consensus on important advantages (i.e. improved efficiency; room for choice). Health economists reached almost no consensus on any factors. GP and MH-care professionals reached most consensus on disadvantages (i.e. focus on price over quality, increased bureaucracy) and desired changes (i.e. reduce bargaining power of healthcare insurers; increase attention for care of complex patients); half of them suggested abolishment of managed competition.
GP and MH-care professionals were most dissatisfied and suggested several changes or even abolishment of the 2006 reform; healthcare insurers mentioned some benefits. This level of dissatisfaction among health care professionals indicates that there is room for improvement, preferably developed in conjunction with stakeholders.
2006 年，荷兰进行了一次重大的医疗改革，引入了管理竞争。本研究旨在探讨对这一新系统的结果和期望变化的共识水平，以及利益相关者群体之间的差异。
在荷兰医疗保险公司、卫生经济学家以及普通科医生和精神科医生之间进行了三轮德尔菲研究。在第一轮中，20 名专家指出了荷兰管理竞争的最重要的优势和劣势，以及期望的变化。第二轮（n=106）和第三轮（N=88）的专家对第一轮确定的 88 个因素的重要性进行了评分。
只有医疗保险公司就重要的优势（即提高效率；选择空间）达成了共识。卫生经济学家几乎没有就任何因素达成共识。普通科和精神科医生对劣势（即关注价格而非质量，增加官僚主义）和期望的变化（即减少医疗保险公司的谈判能力；增加对复杂患者护理的关注）达成了最多的共识；他们中的一半人建议废除管理竞争。
普通科和精神科医生最不满意，并建议对 2006 年的改革进行一些改变，甚至废除；医疗保险公司则提到了一些好处。医疗保健专业人员的这种不满程度表明，有改进的空间，最好与利益相关者共同制定。
