[Health economics and oral care: an introductory anthology]. / Gezondheidseconomie en mondzorg: een inleidende bloemlezing.

Healthcare expenditures will continue to increase in the coming years, raising questions regarding the sustainability of the Dutch healthcare system and solidarity, but also about the optimal use of available resources. Given the issues in the oral care sector, attention for economic insights is appropriate there as well. Relevant issues in this regard are the design of the basic and supplementary health insurance schemes for oral care, the market structure and financing of oral care, questions regarding task shifting in oral care, as well as socio-economic inequalities in oral health. A closer cooperative relationship between oral care and the health economy can help in achieving an optimal and sustainable organisation of the Dutch oral care sector. In other words, an organisation contributing in an efficient and fair way to good oral care for all Dutch citizens.

[The organisation and financing of curative care]. / Organisatie en financiering van de curatieve zorg.

In the Netherlands, market incentives are increasingly used in the organisation of curative healthcare. This use of a free-market system is not an end in itself but rather a way of achieving better care at appropriate prices. Considering the special characteristics of healthcare, this is, however, not self-evident. As a result, the government is still significantly involved. This is also very clear in the financing of healthcare. In the case of curative care, the choice has been made for basic healthcare insurance compulsory for everyone. Medically necessary care pertaining to this coverage, including some oral care, is nearly fully financed collectively in the form of compulsory premiums. Every increase in the cost of care results, consequently, in difficult (political) dilemmas. Within the 'regulated' free-market system of the basic healthcare insurance package as well as the supplementary packages particularly important to oral care, it is essential that healthcare providers and insurers find common ground as contracting parties to a greater and greater degree.

Centralisation of cancer surgery and the impact on patients' travel burden.

Recent years have seen increasing trends towards centralisation of complex medical procedures, including cancer surgery. The impact of these trends on patients' travel burden is often ignored. This study charts the effects of different scenarios of centralising surgery on the travel burden for patients with cancer of the digestive tract, particularly among vulnerable patient groups. Our analyses include all surgically treated Dutch patients with colorectal, stomach or oesophageal cancer diagnosed in 2012-2013. After determining each patient's actual travel burden, simulations explored the impact of continued centralisation of cancer surgery under four hypothetical scenarios. Compared to patients' actual travelling, simulated travel distances under relatively 'conservative' scenarios did not necessarily increase, most likely due to current hospital bypassing. Using multivariable regression analyses, as a first exercise, it is examined whether the potential effects on travel burden differ across patient groups. For some cancer types, under more extreme scenarios increases in travel distances are significantly higher for older patients and those with a low SES. Given the potential impact on vulnerable patients' travel burden, our analysis suggests a thorough consideration of non-clinical effects of centralisation in health policy.

[Do healthcare insurers have too much power?] / Hebben zorgverzekeraars te veel macht?

In the Dutch healthcare system, healthcare insurers act as purchasers of care on behalf of their insured clients. To this end, the insurers form contractual agreements with healthcare providers. In the interest of balanced negotiations regarding price and quality, it is important that neither of the two parties has a disproportionate position of power. This paper discusses whether healthy power relationships exist between healthcare insurers and healthcare providers.