네덜란드에서는 2006년 1월 新건강보험법이 발효되면서 건강보험의 개혁이 이루어졌다. 건강보험 개혁의 핵심은, 전 국민을 강제 적용하는 사회보험의 관리를 정부주도에서 국민이 보험자를 선택할 수 있도록 한 관리된 경쟁시스템의 도입에 있다. 또한 공평한 재정 부담의 원칙하에 국민의 선택권을 보장하였고, 정부의 역할을 보험운영에 관한 최소한의 규제와 위험분산 관리 기능으로 제한하여 민영보험사의 경쟁을 통한 가격인하와 의료의 질을 확보하고자 하였다. 그리고 보험회사가 의료서비스의 공급 시에, 공급자 간의 경쟁을 촉진하는 계약시스템을 도입하여 관리된 경쟁(managed competition)을 실현할 수 있도록 하였다. 네덜란드는 지금까지 사회보험국가에서 보기 어려운 1차 의사에 대한 인두제, 병원에 대하여 예산제와 같은 강력한 공급측면의 통제정책을 사용하였으나, 정부 규제의 한계를 깨닫고 2006년부터 경쟁모형으로 전환하게 되었다. 네덜란드의 관리된 경쟁모형에 의한 의료개혁은 가입자 간의 형평이 보장된다는 전제 하에서 의료분야에도 경쟁의 원리를 도입할 수 있으며, 건강보험과 민영보험의 연계가 가능할 수 있다는 점을 시사하고 있다. 건강보험의 재정안정에 심각한 문제를 가지고 있는 우리나라에서도 향후 개혁안을 모색하는데 있어서 네덜란드 사례는 여러 측면에서 적용가능성을 가진다고 볼 수 있다.

In Netherlands, health care reform was carried out as The New Health Care Law went into effect in January 2006. The core of health care reform is introduction of managed competition model which allows people to select an insurance company which manage compulsory social insurance from governmental management system. And also, the right of choice is secured based on the principle of fair fiscal burden and price cutting and security of healthcare quality are intended to be secured through competition between insurance companies by limiting the role of government to minimum regulation to insurance operation and risk pooling management function. And by allowing insurance companies to introduce contract system which promote competitions between providers when providing healthcare services, managed competition is intended to be realized. Netherlands applied strong supply-side control policies which are rare in social insurance countries such as capitation on the General Practitioner and global budgeting on the hospital. But after realizing the limit of governmental regulation, Netherlands changed to competition model since 2006. The health care reform by managed competition model of Netherlands suggests that the principle of competition can be introduced in healthcare field on the assumption that equities between subscribers are secured and the connection between health insurance and private insurance is possible. The case of Netherlands can be applied in many aspects to future reform of Korean health care which has severe problems in financial security.

In Netherlands, health care reform was carried out as The New Health Care Law went into effect in January 2006. The core of health care reform is introduction of managed competition model which allows people to select an insurance company which manage compulsory social insurance from governmental management system. And also, the right of choice is secured based on the principle of fair fiscal burden and price cutting and security of healthcare quality are intended to be secured through competition between insurance companies by limiting the role of government to minimum regulation to insurance operation and risk pooling management function. And by allowing insurance companies to introduce contract system which promote competitions between providers when providing healthcare services, managed competition is intended to be realized. Netherlands applied strong supply-side control policies which are rare in social insurance countries such as capitation on the General Practitioner and global budgeting on the hospital. But after realizing the limit of governmental regulation, Netherlands changed to competition model since 2006. The health care reform by managed competition model of Netherlands suggests that the principle of competition can be introduced in healthcare field on the assumption that equities between subscribers are secured and the connection between health insurance and private insurance is possible. The case of Netherlands can be applied in many aspects to future reform of Korean health care which has severe problems in financial security.

Netherlands, Health Care Reform, managed competition, Private Health Care insurance