New piece in the NEJM on what we can learn in setting up exchanges from the Netherlands and Switzerland. Some sample wisdom:
But experience in the Netherlands and Switzerland, where insurance exchanges are part of health care reforms that have been ongoing for some time, provides two cautionary lessons. The first is that competitive insurance markets will not contain costs without reforms of the health care purchasing market. In theory, health insurers should negotiate with health care providers on price, volume, and quality of care. Innovative payment methods should result in the purchasing of efficient care. In the United States, there has been little discussion about strengthening the purchasing market, although the ACA intends to promote provider competition by requiring yearly publishing of standard charges for items and services. Experience from the Netherlands and Switzerland shows that such efforts are not enough. Purchasing-market reforms in those countries are a work in progress, but the results so far in terms of cost containment and quality improvement have been negligible.
As the Dutch and Swiss experience shows, even when health insurance exchanges are functioning moderately well, rapid improvements in quality of care (in the health care provision market) and cost containment (in the health care purchasing market) do not automatically follow. Both countries have recognized that reforming the purchasing market is crucial if regulated competition is to succeed. Yet insurers still lack the tools, expertise, and leverage to be competitive purchasers and thereby achieve efficiency in the delivery of health care services; also, the purchasing market on the whole remains heavily regulated. In addition, good data on performance and quality are urgently needed to permit better assessment of value for money.
You know what? Stop wasting time here. Go read the whole thing. It’s not that long.