RESUMO
In January 2006 the Dutch embarked upon a reform of their health care system based upon the principles of regulated competition (Enthoven, 1988). The flagship of the reform was the Health Insurance Act Zorgverzekeringswet), which integrated statutory health insurance and all other (mainly private) health insurance schemes into a single mandated health insurance scheme with free consumer choice that covered the entire population. In the new system, consumers were given free choice of an insurer in order to trigger competition. Private insurers would act as prudent purchasers of health services on behalf of their clients, offering them an attractive health plan in terms of quality and costs. For their part, providers would compete for contracts with insurers. The main policy goals (in policy documents often referred to as public values) of this “market reform” were to achieve a health care system offering high-quality care to patients that would be accessible to every person (universal access), based upon solidarity and affordability (financial sustainability). Another goal of the reform was to enhance freedom of choice. The primary function of the state was to regulate health care and preserve the public values in health care. The Netherlands now has 15 years of experience with regulated competition among private health insurers. This is enough time to find out how the system has worked in practice and what can be learned from the Dutch experience.