REVIEW ARTICLE Translating Dutch: challenges and opportunities in reforming health financing in Ireland P. Ryan Æ S. Thomas Æ C. Normand Received: 30 March 2009 / Accepted: 7 May 2009 / Published online: 4 June 2009 Ó Royal Academy of Medicine in Ireland 2009 Abstract In 2006, Dutch authorities introduced a new health financing system of compulsory private for-profit insurance with strong government regulation. This system has recently attracted attention in Ireland. This paper assesses the theoretical arguments and evidence for applying the Dutch ideas to Ireland. In particular, the authors address how it would help the stated health system policy objectives of improving value for money, fairness and capacity. While the current Dutch reform is still a work in progress, it offers the headline attraction of a single tier system with few waiting lists. Nevertheless, the Dutch system of managed competition may entail risks for Ireland relating to ensuring sufficient system capacity, protecting those on low-incomes and ensuring cost control. Keywords Health system Á Health financing Á Universal access Á Private health insurance Introduction In the recent health service reforms and in the ongoing debate about further changes to the Irish health system, the stated policy objectives are improving value for money (efficiency), fairness (equity) and capacity [1–4]. The recently announced reform proposals by Fine Gael for financing the Irish health system draw heavily on the new Dutch model that was introduced in 2006. While it is too early to draw firm conclusions about the extent to which the Dutch system has achieved the reform objectives, this paper assesses the theoretical arguments and evidence for applying the Dutch ideas to Ireland. In particular, this article looks at similarities and dif- ferences between the Netherlands and Ireland, and the extent to which the Dutch model is likely to overcome the shortcomings in the Irish health system. It is important to take into account the differences when assessing the likely effects of the Dutch model in Ireland. For instance, the Dutch health system has historically been better resourced than in Ireland and the Netherlands has higher taxes. There is greater reliance on income tax in the Netherlands, and the tax system is more progressive than the one in Ireland. Overview of the Dutch system In 2006, Dutch authorities introduced a new health financing system of compulsory 1 private for-profit insur- ance with strong government regulation [5]. This replaced a system where approximately two-thirds of the popula- tion had Social Health Insurance and wealthier individuals could opt out with private health insurance. Competition between private insurance funds is now used to increase efficiency and innovation in the health system. Health insurers compete based on premium, service and quality of care. All insurers must offer to everyone the same standardized basic benefit package (although they can also compete on supplementary insurance packages such as dental care and eyeglasses). This ‘‘managed competition’’ is seen as an alternative to ineffective government cost- control efforts [6]. Insurers must accept every applicant to the basic insurance plan (open-enrollment), and consum- ers can switch plan annually. P. Ryan Á S. Thomas (&) Á C. Normand Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, College Green, Dublin 2, Ireland e-mail: steve.thomas@tcd.ie 1 Citizens who have not enrolled face harsh penalties. 123 Ir J Med Sci (2009) 178:245–248 DOI 10.1007/s11845-009-0365-x