The (construction of a) Global Market for Traded Health Services: The Case of The Netherlands

The purpose of this study is to explore current patterns and trends of Dutch patients consuming healthcare services abroad. In particular, the patient group going abroad with the sole purpose of pursuing an elective non-emergency medical treatment, which is about 35- 45% of all patients consuming healthcare abroad. Economic international trade theory explains why producing simple and standardized health services can be cheaper in low-income countries and how the whole world can benefit from trading health services in a global market. However, these economic theories may not be able to tell the whole story. If things were this obvious and straightforward, would not more people have already gone abroad for treatment? To gain a greater understanding on the topic, this study analyzes from a social-constructivist perspective how a global market for health services is constructed, how social relationships build the actual global market, and how human and non-human entities can be acting forces in the construction of tradable health services. By summarizing existing knowledge, this qualitative case study about Dutch involvement in medical tourism endeavors to inform people to understand how this global market developed and what the gains and risks from trade in healthcare services. Dutch politicians are encouraged to take notice of this study and understand the possible gains for the future, especially regarding the upcoming proposed legislation by Ms. Edith Schippers to withdraw reimbursement outside Europe. In addition, the study suggests that Dutch health insurers seek to establish contracts with health service providers abroad who offer their services at more competitive prices. This way, their role as care path managers can be reinforced. Literature was reviewed, government policies were studied, and interviews with key experts (e.g. decision makers at health insurance companies) with specific knowledge about the topic were conducted. The interviews were used to support and expand the information obtained from the literature and to build a greater understanding on the topic.