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Impressum: zurück zu Startseite. Christian Wette. Eiland Solingen. Tel: Mobil: Mail: [email protected] Details zur Telefonnummer. Telefonnummer: Inhaber und Adresse​: WMG Wette GmbH & Co. KG, Kirchstraße 14 Solingen Stadt: Solingen -. Solingen. Tel: Tel: Mobil: Fax: Mail: [email protected] seit CUX-​Liebhaber. Awesome music with Lyrics / Copyrights: WMG / Esse video foi feito com Jess Sy alishiriki chapisho — akiwa na Thomas Kries wakiwa Hospiz, Wetten. Impressum. Copyright. WETTE IGA OPTIC GmbH. Abteilung Akustik. Abteilung WMG. Eiland Solingen. Telefon: +49 (0) Telefon.

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❌ÖFFNUNGSZEITEN von „Wette IGA Optic GmbH“ in Solingen ➤ Öffnungszeiten heute ☎ Telefonnummer [email protected] (Jetzt Nachricht senden). Impressum: zurück zu Startseite. Christian Wette. Eiland Solingen. Tel: Mobil: Mail: [email protected] Impressum. Copyright. WETTE IGA OPTIC GmbH. Abteilung Akustik. Abteilung WMG. Eiland Solingen. Telefon: +49 (0) Telefon. Wetten Wmg

The searches were restricted to meeting minutes and official papers from the years to , because the Wmg and Zvw were developed during this period.

The documents we initially found were reviewed on title to determine whether they concerned patient choice for healthcare providers. Additionally, we analysed the political agendas of the Dutch Ministry of Health from the years , and and a document from the Dutch Health Care Authority NZa.

Ahgren B, Axelsson R: A decade of integration and collaboration: the development of integrated health care in Sweden — International Journal of Integrated Care.

Google Scholar. Health Econ Policy Law. Greener I: Are the assumptions underlying patients choice realistic?

A review of the evidence. Br Med Bull. Patient Educ Couns. Intensive Crit Care Nurs. Greener I: Who choosing what?

Social policy review: UK and international perspectives. Recent Reforms and Current Policy Challenges. Dutch health policy toward demand-driven care: results from a survey into hospital choice.

Health Care Anal. A questionnaire study. Ubachs R: In eigen hand. Commissie Structuur en Financiering Gezondheidszorg: Bereidheid tot verandering.

N Engl J Med. Enthoven AC: The history and principles of managed competition. Health Aff Millwood. Maarse H: Markthervorming in de zorg.

Een analyse vanuit het perspectief van de keuzevrijheid, solidariteit, toegankelijkheid, kwaliteit en betaalbaarheid. Friele RD: Evaluatie Wet marktordening gezondheidszorg.

J Health Serv Res Policy. Hoogerwerf A, Herweijer M: Overheidsbeleid. Een inleiding in de beleidswetenschap. Leeuw FL: Policy theories, knowledge utilization, and evaluation.

Tweede Kamer: Kamerstuk no. Wet marktordening gezondheidszorg. Maastricht University, personal communication, 1. Tweede Kamer: Handelingen no.

Eerste Kamer: Kamerstuk no. Zekere Zorg: Zekere Zorg. Consumentenbond: Verpleging-, verzorging- en thuiszorgvergelijker. IGZ: Basisset kwaliteitsindicatoren.

Eerste Kamer: Handelingen no. Centrum Klantervaring Zorg: Ontstaan. Een quick scan van aandachtspunten en wetenschappelijke inzichten.

ZonMw: Projecten. Zichtbare Zorg: Programma Zichtbare Zorg. RIVM: Kiesbeter. Wet medisch-wetenschappelijk onderzoek met mensen.

Howlett M, Ramesh M: Studying public policy. Policy cycles and policy subsystems. Download references. We would like to thank all persons we interviewed for our research.

We would also like to thank Mike Wilkinson for copyediting the paper and Juhani Lehto, Christiaan Lako and Hannu Valtonen for editing and reviewing the paper.

Finally, we would like to thank the Dutch Ministry of Education, Culture and Science, which provided funding for this review. Correspondence to Aafke Victoor.

AV participated in the design of the study, carried out the policy document search and selection process, conducted the interviews, analysed the documents, modelled the assumptions and drafted the manuscript.

JR also participated in the design of the study and the modelling of the assumptions and helped to draft the manuscript. All authors participated in modelling the assumptions, drafting the manuscript and reading and approving the final manuscript.

This article is published under license to BioMed Central Ltd. Reprints and Permissions. Victoor, A. Free choice of healthcare providers in the Netherlands is both a goal in itself and a precondition: modelling the policy assumptions underlying the promotion of patient choice through documentary analysis and interviews.

Download citation. Received : 18 April Accepted : 05 October Published : 03 December Skip to main content. Search all BMC articles Search.

Download PDF. Abstract Background In the Netherlands in , a health insurance system reform took place in which regulated competition between insurers and providers is key.

Methods We searched policy documents for assumptions made by policy makers about patient choice of healthcare providers that underlie the health insurance system reform.

Results Our study shows that the government paid much more attention to the instrumental goal of patient choice. Conclusions Various instruments have been put in place to ensure that patients can act as consumers on the healthcare market.

Background In most northwest European countries, such as the Netherlands, Scandinavia and the UK, actively choosing a healthcare provider was traditionally not common.

Table 1 Key elements of the health insurance schemes in the old insurance system compared with the new insurance system Full size table.

Figure 1. The healthcare market. Full size image. Method Modelling the policy assumptions Various methods are described in the literature for modelling the assumptions underlying public policy and how they are interrelated [ 27 , 28 ].

Figure 2. Reconstruction of the causal propositions. Table 2 Reconstruction of the final propositions Full size table.

The causal propositions How can patient choice help to introduce competition and, in the end, achieve the higher-level goals e. The final propositions The Dutch government made various final assumptions.

Side-effects of the policy Several side-effects of the policy on the promotion of patient choice of healthcare providers are mentioned in the policy documents.

Table 3 The side-effects of the policy regarding the enhancement of patient choice of healthcare providers that are mentioned in the policy documents Full size table.

Discussion Patient choice of healthcare providers is an important theme, not only in the Netherlands but in the UK and Scandinavia as well [ 1 — 7 ].

Healthcare provision and the insurance market Although the current study focuses on the choice of providers, the healthcare insurance and provision markets are interrelated.

Limitations, strengths and follow-up research One limitation of this study is that we confined our analysis mainly to policy documents about the Wmg and the Zvw.

Conclusion Patient choice of healthcare providers is both a goal in its own right and a fundamental element in a system in which regulated competition between providers is key.

Appendix A. References 1. NPCF, personal communication, VWS, personal communication, RVZ, personal communication, Acknowledgements We would like to thank all persons we interviewed for our research.

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In practice, this implies a free choice of provider, but those insured may receive only partial reimbursement of the healthcare costs they incur [ 23 — 25 ].

Even so, under the payment-in-kind scheme, the insured persons are legally allowed to choose non-contracted providers but they may potentially receive only partial reimbursement of costs and, in the case of a payment-in-kind policy, insurers have to contract enough providers because they are obliged to deliver care within a reasonable time and at a reasonable distance [ 29 , 37 , 40 — 43 , 46 , 48 — 52 ].

A media campaign was set up by government to make the public aware of the possibilities of choice in healthcare [ 37 , 42 — 44 ]. Providers are obliged to publish understandable, effective and correct comparative information about quality and costs that is not misleading and does not undermine health legislation [ 30 , 38 , 41 , 46 , 53 — 55 ].

Because patients have different information preferences and a number of parties have developed various quality or performance indicators and comparative information, a plethora of information for patients has been produced [ 31 , 35 ].

Patients can consult the information, e. People without Internet access were assumed to request information by phone or at physical desks or to request help from healthcare providers, insurers and user organisations [ 30 , 31 , 37 — 39 , 41 — 44 , 46 , 48 , 56 — 62 ].

This way, their critical attitude towards the costs of healthcare would be influenced positively and, consequently, they would be motivated to demand care only when they really need it [ 29 , 37 , 39 , 40 , 43 , 49 , 63 , 64 ].

Several side-effects of the policy on the promotion of patient choice of healthcare providers are mentioned in the policy documents.

For instance, policy makers assumed that not every patient has Internet access or is able to search the Internet, assess the various alternative providers and make an informed decision.

Because many patients eventually will not choose, the competitive pressure will be diminished [ 37 , 65 , 66 ].

All these side-effects are listed in Table 3. Although the interviewees perceived our model as plausible, they did not agree on issues concerning the context of our model, e.

We therefore reached the conclusion that some aspects of the policy are ambiguous. Firstly, patient choice as postulated in the policy documents refers to individual patients matching their care to their needs by actively choosing providers [ 37 ].

However, in both views, patients who may change provider in order to improve the care they receive are expected to improve healthcare at the macro level [ 34 , 68 ].

Concerning the use of patient choice as an instrument or precondition, the policy documents were unclear about whether patients were expected to take costs into account when choosing a healthcare provider.

The interviewees also did not agree on this matter. We kept costs in our model, but with the idea that with payment-in-kind policies and preferred provider policies patients may be expected only to be aware of the costs of healthcare to prevent excessive care use and to place the responsibility of keeping an eye on the costs of the individual providers on the insurer.

Therefore, in our reconstruction, payment in kind policies or preferred provider policies have a negative influence on the freedom of choice.

However, there is no consensus about how the government defines freedom of choice, i. In our model, we adopted the first meaning, because it is often stated that a reimbursement policy increases the freedom of choice [ 36 ].

Although insurers might be better able to negotiate with insurers than individual patients, the freedom of choice of healthcare providers is assumed to be important for patients.

Patient choice of healthcare providers is an important theme, not only in the Netherlands but in the UK and Scandinavia as well [ 1 — 7 ].

To be able to evaluate whether promoting patient choice of healthcare providers has its desired effects, it must be clear exactly which effects are desired.

For that reason, we modelled the assumptions underlying the promotion of patient choice of healthcare providers by analysing policy documents and interviewing key figures.

We focused our analysis on the Netherlands. However, because much the same assumptions are made by policy makers in the other northern European countries as well [ 14 , 15 , 26 ], our analysis is also interesting for policy makers and researchers in those countries.

In the current paper, we answered four research questions. The first research question concerned the reasons for promoting patient choice. Patient choice of healthcare providers is one important element in a much broader system in which regulated competition between providers and insurers is key to controlling the development of costs and improving and safeguarding the quality, efficiency and accessibility of healthcare [ 31 , 32 ].

Within the context of regulated competition, patients are expected to behave as rational actors.

This line of reasoning originates from the classical economic theory [ 20 , 68 ]. However, in practice, the Dutch government did not really concern itself with this latter goal [ 37 , 88 ].

Because it was assumed that patients value choice, no instruments were implemented to encourage patients to choose.

Even so, literature indicates that a number of patient groups are in reality less inclined or able to choose actively, which may affect the equity of outcomes from patient choice policies [ 8 , 12 ].

The second research question concerned the determinants that were assumed to influence patient choice. It was assumed that satisfying several conditions leads patients to choose a provider rationally.

Those conditions are that patients are willing to choose and willing and able to travel and switch provider, that patients are informed, that there are sufficient healthcare providers to choose from and that patients are free to choose their healthcare provider.

Regarding the third research question, i. This resulted in a health insurance system that relies heavily on laws to regulate the market [ 68 ].

In our analysis, we did not include the supervisors of the healthcare market such as the Dutch Health Care Authority NZa , because we wanted to focus on instruments directed at the patient.

These supervisory bodies were, however, considered essential for markets to develop. Concerning the fourth research question about the side-effects of the policy, several possible side-effects are documented in the policy documents.

If these side-effects exist, diminished competitive pressure and a healthcare provision market that is not really working without governmental intervention may result.

It is however striking that no discussion was documented about the role of equality, neither as a possible negative side-effect of patient choice nor as part of the argument for patient choice.

In several other countries, such as the Nordic countries, there was some concern about the likelihood that introducing choice would result in adjustment of the healthcare system in favour of certain patient groups e.

Other types of patients would be ignored by the providers [ 8 ]. The fact that Dutch policy makers had no concerns about equity is especially interesting because they did expect differences in choice behaviour between different patient groups [ 31 ].

Because policy making is not a straightforward process, some aspects of the policy are ambiguous [ 89 ]. These ambiguities can have a variety of causes.

Secondly, policy on the health insurance system change was not strictly defined; instead, some choices were left open [ 68 ]. Thirdly, in policy documents, assumptions are made and words are used for concepts that cannot be grasped merely by reading written material about the subject [ 34 ].

For example, patient choice is a concept that refers to the indirect influence patients the demand side have on healthcare providers, but it is never explicitly defined as such.

Fourthly, there might not be one single way to understand the policy; instead, words and assumptions that are used in it might have different meanings for different people.

For some policy makers, patient choice refers to individual patients actively choosing a healthcare provider, while for others the concept refers to the threat of competitors that patients might choose.

Finally, the development of the policy on health insurance system change has been a political process during which compromises had to be negotiated, for example regarding which goal of patient choice is the main focus.

There are also other countries, in which patient choice has multiple goals, such as Scandinavia and the UK [ 2 , 8 , 10 , 11 ]. However, the Netherlands is unique, since patient choice as a goal in its own right conflicts with letting insurers contract providers in selectively.

Whereas the latter is essential for the functioning of the new health insurance system and regulated competition [ 18 ], the former was also included in the policy as a goal in its own right [ 69 ].

Although the current study focuses on the choice of providers, the healthcare insurance and provision markets are interrelated.

However, the policy makers involved in the development of the current health insurance system tried to make sure that patients will always have a free choice of provider, independently of their insurance products there may be some financial consequences.

This makes it valid to analyse the healthcare provision market separately from the healthcare insurance market in the Dutch situation.

One limitation of this study is that we confined our analysis mainly to policy documents about the Wmg and the Zvw. This meant that we did not incorporate the history of the health insurance system changes.

We partially solved this issue by consulting additional literature in order to put our reconstruction into context.

Furthermore, we did not have the opportunity to interview the person who was the Minister of Health during the years that the health insurance system acquired its final form.

A strong point of this research is, however, that we held interviews both with key figures involved in the health insurance system change and with people who followed this development closely.

Another strength of this paper is that, as far as we know, few scientific papers have been written either in the Netherlands or abroad that aimed to model the policy assumptions underlying the promotion of patient choice by combining policy document analysis with interviews with key figures.

The current paper therefore expands the body of literature about public policy evaluation, adds to the existing knowledge about regulated competition in healthcare, and will enable future research on the validity of this policy, e.

Patient choice of healthcare providers is both a goal in its own right and a fundamental element in a system in which regulated competition between providers is key.

Several instruments have been put in place to ensure that patients can act as consumers on the healthcare market: making sure that they are well-informed and that the insurance system poses no barriers.

There has been much less attention for the willingness and ability of patients to choose, i. Also, the consequences on equity of outcomes if several patient groups are less inclined or capable to choose actively received little attention.

This database contains all policy documents, policy letters and minutes of meetings of the Dutch House of Representatives and the Dutch Senate.

The searches were restricted to meeting minutes and official papers from the years to , because the Wmg and Zvw were developed during this period.

The documents we initially found were reviewed on title to determine whether they concerned patient choice for healthcare providers. Additionally, we analysed the political agendas of the Dutch Ministry of Health from the years , and and a document from the Dutch Health Care Authority NZa.

Ahgren B, Axelsson R: A decade of integration and collaboration: the development of integrated health care in Sweden — International Journal of Integrated Care.

Google Scholar. Health Econ Policy Law. Greener I: Are the assumptions underlying patients choice realistic? A review of the evidence.

Br Med Bull. Patient Educ Couns. Intensive Crit Care Nurs. Greener I: Who choosing what? Social policy review: UK and international perspectives.

Recent Reforms and Current Policy Challenges. Dutch health policy toward demand-driven care: results from a survey into hospital choice.

Health Care Anal. A questionnaire study. Ubachs R: In eigen hand. Commissie Structuur en Financiering Gezondheidszorg: Bereidheid tot verandering.

N Engl J Med. Enthoven AC: The history and principles of managed competition. Health Aff Millwood. Maarse H: Markthervorming in de zorg.

Een analyse vanuit het perspectief van de keuzevrijheid, solidariteit, toegankelijkheid, kwaliteit en betaalbaarheid.

Friele RD: Evaluatie Wet marktordening gezondheidszorg. J Health Serv Res Policy. Hoogerwerf A, Herweijer M: Overheidsbeleid. Een inleiding in de beleidswetenschap.

Leeuw FL: Policy theories, knowledge utilization, and evaluation. Tweede Kamer: Kamerstuk no. Wet marktordening gezondheidszorg.

Maastricht University, personal communication, 1. Tweede Kamer: Handelingen no. Eerste Kamer: Kamerstuk no. Zekere Zorg: Zekere Zorg.

Consumentenbond: Verpleging-, verzorging- en thuiszorgvergelijker. IGZ: Basisset kwaliteitsindicatoren. Eerste Kamer: Handelingen no.

Centrum Klantervaring Zorg: Ontstaan. Een quick scan van aandachtspunten en wetenschappelijke inzichten. ZonMw: Projecten.

Zichtbare Zorg: Programma Zichtbare Zorg. RIVM: Kiesbeter. Wet medisch-wetenschappelijk onderzoek met mensen. Howlett M, Ramesh M: Studying public policy.

Policy cycles and policy subsystems. Download references. We would like to thank all persons we interviewed for our research.

We would also like to thank Mike Wilkinson for copyediting the paper and Juhani Lehto, Christiaan Lako and Hannu Valtonen for editing and reviewing the paper.

Finally, we would like to thank the Dutch Ministry of Education, Culture and Science, which provided funding for this review. Correspondence to Aafke Victoor.

AV participated in the design of the study, carried out the policy document search and selection process, conducted the interviews, analysed the documents, modelled the assumptions and drafted the manuscript.

JR also participated in the design of the study and the modelling of the assumptions and helped to draft the manuscript.

All authors participated in modelling the assumptions, drafting the manuscript and reading and approving the final manuscript.

This article is published under license to BioMed Central Ltd. Reprints and Permissions. Victoor, A. Free choice of healthcare providers in the Netherlands is both a goal in itself and a precondition: modelling the policy assumptions underlying the promotion of patient choice through documentary analysis and interviews.

Download citation. Received : 18 April Accepted : 05 October Published : 03 December Skip to main content. Search all BMC articles Search.

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De Nederlandse Zorgautoriteit NZa is de markttoezichthouder in de zorg. Zij ziet erop toe dat alle partijen zich aan de regels houden en dat de zorgmarkten goed blijven functioneren.

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