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Keywords:

  • barriers;
  • health insurance system;
  • health policy;
  • intention to switch;
  • switching behaviour

Abstract

Background  Several western countries have introduced managed competition in their health care system. In the Netherlands, a new health insurance law was introduced in January 2006 making it easier to switch health insurer each year.

Objective  The objective was to measure people’s intention to switch health insurer and actual switching behaviour. We also examined whether some groups were less inclined to switch health insurer and/or had more difficulty to exert their intention to switch.

Design  In October 2006, members of three Dutch panels indicated whether they intended to switch health insurer during that year’s open enrolment period. In the beginning of 2007, the same people were asked whether they indeed switched health insurer.

Results  Only 1% intended to switch health insurer. Women, older people, lower educated people, people who were insured for a longer period and people who reported a bad or moderate health were less inclined to switch health insurer. The amount of switching was higher among individuals who intended to switch (31%) than among individuals who did not know whether they would switch (7%) and individuals with no intention to switch (2%). Among those who intended to switch health insurer, women and people who reported a good health switched health insurer more often. The years of enrolment were also associated with actual switching behaviour.

Discussion and Conclusions  We might have to temper the optimistic expectations on enhanced choice. Future research should determine why people do not switch health insurer when they intend to and which barriers they experience.