Dalhousie Law Journal


Netherlands, reform, health care, Dutch, Canada, decentralization, planning, funding, competition model


This article provides an economic and legal perspective on the managed competition reforms within the Netherlands. After an examination of the rationale and the main features of the reforms, a number of problems and dilemmas that were encountered during the implementation process will be highlighted. The authors conclude that although the logic of the managed competition model is appealing, its implementation is quite complicated and requires a strong government with a continued commitment to set and enforce the rules of competition. If these preconditions are not met, the prospects of a successful introduction of managed competition are bleak. Despite its different health care system, Canada may benefit from the Dutch reform experience, especially if the trend towards decentralization of health planning and funding continues. In particular, the need for an adequate definition of entitlement to health care will become more pronounced.