Die discussie over selectie is al jaren geleden volledig uitgevlooid: onuitvoerbaar. Gebrek aan kennis is de belangrijkste bron van dit soort luchtballonnen, of de noodzaak tot de media halen. Dat is Kingma in ieder geval gelukt.

@ANH Jansen: Helaas ben ik het met je eens dat in veel gevallen de USA ons “voorland” is. maar heb je ook enig idee hoe ze het doen in Denemarken of België? Lijkt me belangwekkender dan ons af te stemmen op het volkomen asociale “voorland” Amerika voor wat betreft het ziektekostenstelsel met hoe het niet of wel zou moeten.

ANH Jansen een linkje naar de betreffende tekst zou zeker zo mooi zijn.
Ben het met schippers eens de willekeur is onuitvoerbaar, je bent dronken valt en breek je been. Welke kosten vallen er dan wel en welke niet onder je “eigen risico” of komt alle gevolgschade er ook bij?

En wat zegt ons voorland?
http://www.nejm.org/doi/full/10.1056/NEJMp0903166
What Works in Market-Oriented Health Policy?
Meredith B. Rosenthal, Ph.D.
N Engl J Med 2009; 360:2157-2160May 21, 2009
“Many efforts to improve health care markets involve providing consumers with technical decision support — helping them to determine when to seek care, how to manage chronic conditions, and how to participate in decisions regarding treatment choices. Payers have invested billions of dollars in efforts to engage patients in self-care and making decisions about treatment. Evidence of the efficacy of such efforts, however, is in short supply. Disappointing results from the recent Medicare experiment with disease-management services provided by third parties have called into question the approaches most commonly used to engage consumers.3
Substantial effort has also gone into arming consumers with information to help them select physicians and hospitals that are high-quality, low-cost, or both. The combined goals of this effort are improving average quality or efficiency by directing patients to the best providers and creating competition among providers by inspiring them to improve care along the dimensions that are assessed and reported. Provider report cards have been available and evolving since the 1980s, but research has cast doubt on their value, since patients frequently do not understand, trust, or rely on such reviews in selecting providers.”
“Although reformers point to economic principles to support market-oriented policies, in many cases there is a gap between belief and evidence. Yet research and practice with such policies provide some lessons. First, consumers and providers respond predictably to policies requiring them to share the burden of health care costs: they find ways to reduce utilization and spending. Second, there is strong evidence that increased consumer cost sharing causes unintended reductions in the use of services that are important for better health — a problem unlikely to be solved by simply offering consumers information or advice. But no similar body of evidence documents negative effects on quality from increased risk sharing by providers. Moreover, providers’ information advantage over consumers, along with professional ethics, suggests that essential or effective services are less likely to be underused as a consequence of provider risk sharing than consumer cost sharing. Pay for performance and risk adjustment could minimize any negative effects on the quality of care.”
The focus on providers should not mean an absence of involvement by patients in improving the effectiveness and efficiency of care. Along these lines, there may be promise in efforts to reward consumers for the same care-quality processes included in provider pay for performance. Consumers, too, must have some perceived financial stake — and choices — in cost control. Offering them a financial incentive to entrust their care to a provider team with the capabilities and incentives to deliver coordinated, effective, and efficient care might be a near-term way of accomplishing this goal.
No potential conflict of interest relevant to this article was reported.
Source Information
Dr. Rosenthal is an associate professor of health economics and policy at the Harvard School of Public Health, Boston.
Tja. Ons voorland, de USA, heeft e.a. allang uitgeprobeerd en terzijde geschoven.
Overigens komt E Schippers met en vermogenstoets voor de berekening en toekenning van de zorgtoeslag. Insteek van de Overheid is afbouw van de zorgtoeslag en zeker niet vergroting. Teveel verplicht verzekerden kunnen de hoge nominale premie niet meer betalen.
Hoe zouden ze dat toch hebben voorkomen in landen met een werkelijk sociaal verzekeringsstelstel?
Even bellen naar Denemarken of België?

Dat komt ervan, dat de ouderen onder het juk van de jongeren door moeten gaan!”heb eerbied voor ouderen”-leus moet meer toegepast worden en doorgang vinden in de opvoeding!Back to the Fyfties