+1 Recommend
0 collections
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Advice from the health insurer as a channelling strategy: a natural experiment at a Dutch health insurance company

      Read this article at

          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.



          In a health care system based on managed competition it is important that health insurers are able to channel their enrolees to preferred care providers. However, enrolees are often very negative about financial incentives and any limitations in their choice of care provider. Therefore, a Dutch health insurance company conducted an experiment to study the effectiveness of a new method of channelling their enrolees. This method entails giving enrolees advise on which physiotherapists to choose when they call customer service. Offering this advice as an extra service is supposed to improve service quality ratings. Objective of this study is to evaluate this channelling method on effectiveness and the impact on service quality ratings.


          In this experiment, one of the health insurer’s customer service call teams (pilot team) began advising enrolees on their choice of physiotherapist. Three data sources were used. Firstly, all enrolees who called customer service received an online questionnaire in order to measure their evaluation of the quality of service. Enrolees who were offered advice received a slightly different questionnaire which, in addition, asked about whether they intended to follow the advice they were offered. Multilevel regression analysis was conducted to analyse the difference in service quality ratings between the pilot team and two comparable customer service teams before and after the implementation of the channelling method. Secondly, employees logged each call, registering, if they offered advice, whether the enrolee accepted it, and if so, which care provider was advised. Thirdly, data from the insurance claims were used to see if enrolees visited the recommended physiotherapist.


          The results of the questionnaire show that enrolees responded favorably to being offered advice on the choice of physiotherapist. Furthermore, 45% of enrolees who received advice and then went on to visit a care provider, followed the advice. The service quality ratings were higher compared to control groups. However, it could not be determined whether this effect was entirely due to the intervention.


          Channelling enrolees towards preferred care providers by offering advice on their choice of care provider when they call customer service is successful. The effect on service quality seems positive, although a causal relationship could not be determined.

          Electronic supplementary material

          The online version of this article (10.1186/s12913-018-3624-6) contains supplementary material, which is available to authorized users.

          Related collections

          Most cited references 33

          • Record: found
          • Abstract: not found
          • Article: not found

          Trust in Physicians and Medical Institutions: What Is It, Can It Be Measured, and Does It Matter?

            • Record: found
            • Abstract: not found
            • Article: not found

            The History And Principles Of Managed Competition

             A Enthoven (1993)
              • Record: found
              • Abstract: found
              • Article: not found

              Universal mandatory health insurance in the Netherlands: a model for the United States?

              Policy analysts consider the Netherlands health system a possible model for the United States. Since 2006 all Dutch citizens have to buy standardized individual health insurance coverage from a private insurer. Consumers have an annual choice among insurers, and insurers can selectively contract or integrate with health care providers. Subsidies make health insurance affordable for everyone. A Risk Equalization Fund compensates insurers for enrollees with predictably high medical expenses. The reform is a work in progress. So far the emphasis has been on the health insurance market. The challenge is now to successfully reform the market for the provision of health care.

                Author and article information

                [1 ]ISNI 0000 0001 0681 4687, GRID grid.416005.6, NIVEL (Netherlands institute for health services research), ; Otterstraat 118-124, 3513 CR Utrecht, The Netherlands
                [2 ]ISNI 0000 0004 0501 5439, GRID grid.36120.36, Open University, ; Valkenburgerweg 177, 6419 AT Heerlen, The Netherlands
                [3 ]ISNI 0000 0001 0481 6099, GRID grid.5012.6, Maastricht University, ; Duboisdomein 30, 6229 GT Maastricht, The Netherlands
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                6 November 2018
                6 November 2018
                : 18
                © The Author(s). 2018

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

                Research Article
                Custom metadata
                © The Author(s) 2018


                Comment on this article