title: Empowering the chronically ill? Patient collectives in the new Dutch health insurance system.
abstract: On January 1, 2006, the Dutch government instituted major reforms to the country's health insurance scheme. One of the features of the new system is the opportunity for groups to form collectives that may negotiate and enter into group contracts with health insurers. This article discusses one particular type of collective, namely patient collectives. The purpose of this paper is to investigate if, and to what extent, patient collectives empower chronically ill patients. The results of the study show that some patient groups were able to contract collective agreements with health insurers, whereas others were not. The eligibility of a group's disease for compensation through the risk equalisation fund (which subsidises the costs for many but not all disorders) seems to determine whether or not a patient organisation is able to successfully negotiate a collective contract for its members. Another key factor for success is the presence of a large membership whose constituents have similar healthcare needs. If both of these factors are present, insurers are more likely to develop specific products for particular groups of patients, as is the case for people with diabetes. Furthermore, the presence of patient collectives accords patient associations with a new role. It may be possible for them to become powerful players in the health insurance market. However, this new role may also lead to tensions, both within and between associations.
authors.affiliation: Department of Health Organization, Policy and Economics, Faculty of Health, Medicine and Life Sciences, University of Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands. Y.Bartholomee@beoz.unimaas.nl
authors.forename: Yvette
authors.initials: Y
authors.lastname: Bartholomée
authors.forename: Hans
authors.initials: H
authors.lastname: Maarse
mesh_terms: D002908:Chronic Disease; D032982:Contracts; D018166:Health Care Reform; D006801:Humans; D019458:Insurance Coverage / Q000458:organization & administration*; D007407:Interviews as Topic; D009313:National Health Programs; D009426:Netherlands; D011050:Policy Making; D011209:Power, Psychological