Jan-Kees Helderman, assistant professor in Comparative Governance and Public Policy at Radbouyd University Nijmegan, outlines how the Dutch health care system operates and reflects on the English health reforms.

2. Changing the Rules or the Game? Liberating the NHS?

5. (Source: Davis K., Schoen, C., Stremikis, K (2010) Mirror, Mirror on the Wall, Commonwealth Fund)

7. A short historical overview of Dutch health care Private health insurance White paper: Health on Demand (2001) Simons-plan (1993) Exceptional Medical Expenses Act (1968) National Health Insurance under private law, January 1 st , 2006 Mid 19 th century – World War II: Voluntary sickness funds Purple coalitions (1994-2001) Et Voila! Centre-right Cabinet (2001-2007) 30 Access to Health Insurance Act (1986) Sickness fund decree (1941) Sickness Fund Act (1964) Dekker-proposals (1987)

11. Central Health Insurance Fund employer State (Ministry of Public Health, Well-being and Sports) citizen Health care allowance State contribution (5%) Income-dependent contribution (50%) Health insurer Health care provider Nominal premium (45%) Reimbursement of costs -/- personal excess Payment of health care bills The Dutch Health Insurance System Income solidarity Income solidarity Risk-adjustment subsidies Risk Solidarity Selective contracting: A /B segment Monitoring & Supervision: Inspectorate for Health Care / Dutch Competion Authority / Dutch Health Care Authority HEALTH CARE INSURANCE BOARD

13. Gradual institutional change “ Detailed descriptions of types of incremental meandering would also be interesting; perhaps this would more clearly differentiate between a sequence that lead to reform and another that leads to revolution.” (Hirschman en Lindblom, 1962: 221). Detailed descriptions of types of incremental meandering would also be interesting; perhaps this would more clearly differentiate between a sequence that leads to reform and another that leads to revolution.” (Hirschman en Lindblom, 1962: 221) Time: 2006 Displacement New Health Insurance Act 1987 BLUEPRINT The Dekker Plan Conversion 1986 Layering Access to Health Insurance Act Gradual improvement of risk equalisation Gradual introduction of competition Gradual convergene of health insurers 1980 Drift Little reformist change (passive political agency) Large reformist change (active political agency) Figure 1. The extent of institutional change and associated ‘levels’ of agency