Health Reform

Health Insurance Exchanges: Lessons from Switzerland and the Netherlands

Health reforms in Switzerland and the Netherlands in 1996 and 2006, respectively, created managed competition in the countries’ health insurance markets.  These insurance markets are somewhat similar to what is being proposed through the ACA’s health insurance exchnages.  Ewout van Ginneken, Katherine Swartz, and Philip Van der Wees (2013) suggest that these implemenations offer 5 key lessons  for U.S. policymakers to follow.

First, risk-adjustment mechanisms—which provide premium adjustments intended to compensate health plans for enrolling people expected to have high medical costs—need to be sophisticated and continually updated. Second, it is important to determine why people eligible for coverage don’t enroll and to craft responses that will overcome enrollment barriers. Third, applying for subsidies must be simple. Fourth, insurers will need bargaining power similar to that of providers to create a level playing field for negotiating about prices and quality of services, and interim cost containment measures may be necessary. Fifth and finally, insurers and consumers alike will need meaningful information about providers’ costs and quality of care so they can become prudent purchasers of health services, since managed competition among health plans by itself will not substantially drive down health costs.


  • Ewout van Ginneken, Katherine Swartz, and Philip Van der Wees (2013). Health Insurance Exchanges In
    Switzerland And The Netherlands Offer Five Key Lessons For The Operations Of US Exchanges. Health Affairs.

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