Rotterdam 9 – 10 December 2010
“In the late 1990s, the Dutch government started to experiment with ‘regulated competition’ in social health insurance. A milestone was the new Health Insurance Act in 2006 introducing a compulsory health insurance scheme for the entire population, carried out by (for-profit) health insurers, contracting individual and institutional health professionals. Safeguarding equal access, the new health insurance scheme introduced several preconditions like compulsory insurance, a basic benefit package, the prohibition of risk selection, a risk-equalization fund, etc. The idea of competitive health insurance was combined with deregulating hospital planning and liberalizing health care tariffs.
In the new scheme medical need is still decisive in health care access decision-making, but merit-considerations are becoming important too. Shortening waiting times, priority arrangements were considered and/or introduced, based on non-medical criteria. Simultaneously, in terms of financing, health status has become important due to own payments-arrangements, limited insurance package options, etc. At the same time, health status disparities due to socioeconomic inequalities seem to be increasing.
Under these circumstances, confronted with increased health spending, we can expect the R-word becoming more eminent in the Dutch health care debate. Emerging relevant questions are: Who is responsible for rationing (the market, governments, bureaucrats, physicians or others)?; How does it function (explicit or implicit)?; What are relevant and acceptable selection criteria (QUALYs, DALYs, health status, sexe, age, etc)?; To what extent is current rationing just?; What can be done to make it more just?; How will health care rationing affect equal access to health care?; What is the relationship between health care rationing and differences in health status?, etc.
There is a wealth of literature in political theory, as well as in health care policy, economics, social medicine and law addressing these issues. What is needed is a consideration of the values involved and the impact of policy decisions on the expression of these values. Therefore, the Erasmus Observatory organizes an international conference, discussing health care rationing from a wide range of perspectives.”
– Dr. Bert Boer, Executive member of the Board, Health Care Insurance Board (CVZ) (health policy)
– Prof. Werner Brouwer (Erasmus University Rotterdam) (economics)
– Prof. Norman Daniels (Harvard University) (philosophy, medical ethics)
– Prof. Leonard Fleck (Michigan State University) (philosophy)
– Prof. Colleen Flood (Toronto University) (law)
– Dr. Anand Grover (Special Rapporteur United Nations) (law)
– Prof. John Harris (University of Manchester) (bioethics)
– Prof. Frances Kamm (Harvard University) (philosophy)
– Prof. Johan Mackenbach (Erasmus University Rotterdam) (public health)
– Prof. Alan Maynard (University of York) (economics)
– Prof. Chris Newdick (University of Reading) (law)
– Prof. Erik Nord (University of Oslo) (economics)
– Prof. Bettina Schöne-Seifert (Münster University) (medical ethics)
– Dr. Keith Syrett (University of Bristol) (law)