PhD defence Franciscus Johannes Petrus van der Hulst

Keywords: Trust, Health insurers, Managed competition, Selective contracting

"Trust in Health Insurers: Enrollees’ trust related to the functioning of a healthcare system based on managed competition"

This dissertation examined the role of enrollees’ trust in health insurers within the Dutch healthcare system, based on the principle of managed competition. The findings show that, although trust in health insurers is relatively low, it does not directly influence switching behaviour or the choice of health insurance policies with restrictive conditions. Instead, limited knowledge about policy conditions and the role of health insurers appears to be a more important barrier to the intended functioning of the healthcare system. This reduces the effectiveness of selective contracting and may lead to unexpected healthcare costs.

The dissertation further demonstrates that trust is important for the acceptance of healthcare advice, an instrument used to steer enrollees towards preferred providers. Higher levels of trust are associated with a greater willingness to seek and accept advice. In addition, trust is related to the extent to which enrollees’ expectations align with the statutory tasks of health insurers. The findings underline the importance of transparent communication, better information provision and greater awareness among enrollees of the societal role of health insurers.

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