Condition | Risk | Effect |
---|---|---|
Willingness/ability to travel/choose | Some patients are not willing or able to travel or choose. | |
 | There is an urgent situation. | Patients do not have time to search providers [56]. |
Sufficient choice | Healthcare providers and insurers enlarge (especially high quality-providers) or merge. Additionally, the plethora of rules implemented to regulate the market will lead to diminished entrepreneurial activity. | Patients do not have sufficient choice options [41, 83] and costs will increase [84, 85]. Consequently, there may not be enough competitive pressure [41, 51]. |
 | Patients have too many choice options. | Patients may delay choice [84]. |
Transparency – quality | The comparative information that is to be developed will be opaque, excessive, incomprehensible, not comparable, scattered and the various healthcare providers often are disparate. | Patients are unable to assess the quality of the providers and consequently cannot be critical about quality, are unwilling to pay for quality and focus on price information instead [41, 65, 86]. Consequently, there will not be enough competitive pressure [38]. |
 | Not every patient has Internet access or is able to search the Internet, assess the different options and make an informed decision. | Inequalities exist in the accessibility of the comparative information and ability to choose. Consequently, many patients will not choose and the competitive pressure will be diminished [37, 65, 66]. |
 | Healthcare providers have to deliver a large amount of data. | Transparency is hindered [86]. |
 | The bureaucracy of the system leads to possibilities for data to be manipulated. | Providers show strategic behaviour and commit fraud [83]. |
 | Patients choose based solely on information about quality. | The relationship of mutual trust between patient and doctor is being undermined [83]. |
Transparency - costs | Patients do not get to see their healthcare costs, only have to pay a small premium. | Patients are often unaware of the costs that they incurred, which limits their cost awareness. This might diminish the influence of the financial incentives to avoid excessive care use [40, 83, 84]. |
Freedom of choice | Insurers contract a limited number of providers. | |
 | Only the ‘rich’ are able to choose a policy which offers them free choice. | Inequalities exist in the freedom of choice patients have [40, 85]. |
 | Insurers do not buy high-cost care in order to fend off high-risk insured parties. | Inequalities exist in the choices people have [37]. |