title: Regulated competition in health care: switching and barriers to switching in the Dutch health insurance system.
abstract: BACKGROUND
  In 2006, a number of changes in the Dutch health insurance system came into effect. In this new system mobility of insured is important. The idea is that insured switch insurers because they are not satisfied with quality of care and the premium of their insurance. As a result, insurers will in theory strive for a better balance between price and quality. The Dutch changes have caught the attention, internationally, of both policy makers and researchers. In our study we examined switching behaviour over three years (2007-2009). We tested if there are differences in the numbers of switchers between groups defined by socio-demographic and health characteristics and between the general population and people with chronic illness or disability. We also looked at reasons for (not-)switching and at perceived barriers to switching.
  
  
  METHODS
  Switching behaviour and reasons for (not-)switching were measured over three years (2007-2009) by sending postal questionnaires to members of the Dutch Health Care Consumer Panel and of the National Panel of people with Chronic illness or Disability. Data were available for each year and for each panel for at least 1896 respondents - a response of between 71% and 88%.
  
  
  RESULTS
  The percentages of switchers are low; 6% in 2007, 4% in 2008 and 3% in 2009. Younger and higher educated people switch more often than older and lower educated people and women switch more often than men. There is no difference in the percentage of switchers between the general population and people with chronic illness or disability. People with a bad self-perceived health, and chronically ill and disabled, perceive more barriers to switching than others.
  
  
  CONCLUSIONS
  The percentages of switchers are comparable to the old system. Switching is not based on quality of care and thus it can be questioned whether it will lead to a better balance between price and quality. Although there is no difference in the frequency of switching among the chronically ill and disabled and people with a bad self-perceived health compared to others, they do perceive more barriers to switching. This suggests there are inequalities in the new system.
authors.affiliation: NIVEL-Netherlands Institute for Health Services Research, 3500 BN Utrecht, The Netherlands. m.reitsma@nivel.nl
authors.forename: Margreet
authors.initials: M
authors.lastname: Reitsma-van Rooijen
authors.forename: Judith D
authors.initials: JD
authors.lastname: de Jong
authors.forename: Mieke
authors.initials: M
authors.lastname: Rijken
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003163:Competitive Behavior; D003258:Consumer Behavior / Q000706:statistics & numerical data*; D005260:Female; D006296:Health Services / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012647:Self-Assessment; D012737:Sex Factors; D011795:Surveys and Questionnaires; D055815:Young Adult