Health Care Utilization in The Netherlands

Abstract This thesis investigates changes in health care utilization in the Netherlands after the introduction of a new health insurance system in January 2006. The objective of this thesis is to analyze whether the new health insurance system is an influencing factor of the change in health care utilization. Data were obtained from the Permanent Onderzoek Leefsituatie (POLS) for the years 2004 to 2007. In this thesis, corrections were made for age, gender, marital status, family size, nationality, self-assessed health, chronic conditions and education. To test whether health care use changed after the reform, overall levels of health care utilization were investigated, as well as changes of utilization for different levels of education and the type of health insurance people had before the reform. Changes between these groups before and after the reform were tested. While this study observed that overall levels of some types of health care use changed after the reform, whether total health care utilization increased or decreased was not clear. Generally, inequity in the number of visits to specialists seemed to have increased. For physiotherapy visits there was a decreased inequity by level of education as evidenced by the increased utilization of physiotherapy by the lowest education groups while the utilization in the higher education groups remained constant. For other types of health care use, inequity between people with different education levels stayed the same. Analysis of changes in health care use between people with different types of health insurance coverage suggested that those who were previously publically insured visited a general practitioner less often after the reform than before. A decrease in inequity of dental care utilization was also observed while inequity in the number of specialist visits increased after the reform between people with different types of health insurance coverage. While it can be concluded that health care use changed after the reform, the change in the health insurance system is not the only factor that could have influenced this change. Also family care giver usage changed significantly, while family care giver coverage did not change after the Health Insurance Reform. Increasing waiting times, satisfaction about the health care system and differences in treatment methods after the reform may also explain changes in health care utilization after the reform.