title: Stuck in the middle?: A perspective on ongoing pro-competitive reforms in Dutch mental health care.
abstract: Pro-competitive reforms have been implemented in many Western healthcare systems, of which the Netherlands is a prominent example. While the pro-competitive reforms in the Dutch specialized care sector have drawn considerable academic attention, mental health care is often excluded. However, in line with other segments of specialized care, pro-competitive legislation has formed the core of mental health care reforms, albeit with several notable differences. Ever since mental health services were included in the Health Insurance Act in 2008, the Dutch mental healthcare sector has been in an ongoing state of reform. Numerous major and minor adaptations have continuously altered the services covered by the basic insurance package, the actors responsible for providing and contracting care, and definitions and measurements of quality. Most notably, insurers and municipalities, which are responsible for selectively contracting those providers that offer high value-for-money, seem insensitive to quality aspects. The question whether the Dutch mental health sector has inherited the best or the worst of a competitive and non-competitive system lingers and international policy makers contemplating reforming their mental health sector should take note.
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands. Electronic address: d.westra@maastrichtuniversity.nl.
authors.forename: Daan
authors.initials: D
authors.lastname: Westra
authors.affiliation: Mondriaan Mental Health Foundation, Kloosterkensweg 8, 6419 PJ Heerlen, The Netherlands. Electronic address: g.wilbers@mondriaan.eu.
authors.forename: Gloria
authors.initials: G
authors.lastname: Wilbers
authors.affiliation: Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, 6229 GT Maastricht, The Netherlands. Electronic address: federica.angeli@maastrichtuniversity.nl.
authors.forename: Federica
authors.initials: F
authors.lastname: Angeli
mesh_terms: D018166:Health Care Reform / Q000379:methods* / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D007348:Insurance, Health; D018854:Managed Competition; D008605:Mental Health Services / Q000592:standards; D009426:Netherlands; D011057:Politics; D011787:Quality of Health Care
keywords: Health care reform; Health policy; Managed competition; Mental health services; Netherlands; Psychiatric services; Quality of health care