Commercial health care financing: the cause of US, Dutch, and Swiss health systems inefficiency?

Jean-Pierre Unger, Pierre De Paepe

    Research output: Contribution to journalA1: Web of Science-articlepeer-review


    This article evaluates the performance of 3 industrialized nations that have pursued market-based financing models, focusing on equity in access to care, care quality, health status, and efficiency. It then assesses the consistency of the findings with those of different research teams. Using secondary data obtained from a semi-structured review of articles from 2000 to 2017, we discuss the hypothesis that commercial health care insurance is detrimental to accessing professional health care and to population health status. The results show that in 2010 the unmet care needs of both poor and rich Americans exceeded those of the poor in several industrial countries. The number of Dutch adults experiencing financial obstacles to health care quadrupled between 2007 and 2013, and 22% of Swiss adults reported skipping needed care in a 2016 survey. The most negative impacts of "managed care" on care quality are its tight constraints on physicians' professional autonomy; a large reliance on the physicians' material motivation; health service fragmentation; and the tendency to apply evidence-based medicine too rigidly. Countries with a commercial insurance monopoly generally remained above the maternal, infant, and neonatal mortality rates versus the health-spending regression line. We conclude that the most inefficient system is where the insurance market has achieved its maximal development and that care industrialization contributes to the comparatively poor performance of the U.S., Dutch, and Swiss health systems.

    Original languageEnglish
    JournalInternational Journal of Health Services
    Issue number3
    Pages (from-to)431-456
    Number of pages26
    Publication statusPublished - 2019


    • health insurance
    • health care financing
    • health systems research
    • United States
    • The Netherlands
    • Switzerland
    • European health policy
    • commercially managed care
    • care quality
    • POLICY
    • ACCESS
    • REFORM


    Dive into the research topics of 'Commercial health care financing: the cause of US, Dutch, and Swiss health systems inefficiency?'. Together they form a unique fingerprint.

    Cite this