Few switchers in the new Dutch health insurance system, chronically ill and disabled perceive more barriers than others.

Background: In 2006, a number of changes in the Dutch health insurance system came into effect. In the new system mobility of insured is important. The idea is that insured switch because they are dissatisfied with quality and premium. As a result insurers will strive for a better quality-price balance. Internationally, the Dutch changes are under the attention of both policy makers and researchers. In our study we examined switching behaviour and reasons for (non-)switching in 2007, 2008 and 2009 and compared the general population with the chronically ill and disabled. Methods: Switching behaviour and reasons for (non-)switching were measured in 3 years using the Dutch Health Care Consumer Panel and the National Panel of the Chronically ill and Disabled. Data were available for each year and for each panel for at least 1896 respondents (response between 71 and 88%). Results: The number of switchers is low (6% in 2007, 4% in 2008 and 3% in 2009). Older people, women and lower educated people switch less often. For switching, premium is more important than quality of care. There is no difference in number of switchers between the general population and chronically ill and disabled. People with a low perceived health, and chronically ill and disabled do perceive more barriers for switching than others. Conclusions: The percentages of switchers are lower than in 2006 and are comparable to the old system. Switching is not based on quality and thus it can be questioned whether it lead to quality improvement. Although the chronically ill and disabled and people with a low perceived health did not differ in frequency of switching from others, they perceived more barriers for switching. This possibly points at inequalities in the new system. (aut. ref.)