Rising costs are no surprise. There doesn't appear to be direct collusion between insurers, but there is no real competition either. Do you think an insurer would prefer to charge a €100 monthly premium to cover a €1000 average yearly medical bill, or charge €200 premium for a €2000 bill? And prices are further inflated by empire building, ie. setting up and staffing a bunch of auxiliary functions and services that are not directly related to healthcare (and in practise do not work to benefit health either)
Since everybody has mandatory insurance for a fixed package of health care items, what added value do the insurers actually have? There's a few things that are mentioned from time to time:
- efficiency in operation. State-run schemes are notoriously bureaucratic, but there's no indication that private insurers are any more efficient; on the contrary. Especially since there are multiple companies, each with separate administration and management.
- purchasing savvy. Again, there's no indication that they are better at buying care and medicine than, for instance, the New Zealand govt which managed to get a massive discount on medicine.
- value added services like fitness programmes, health awareness campaigns, etc. this amounts to little more than the aforementioned empire building, and appears to add very little value.
I'd much prefer the Dutch government to handle basic insurance themselves, leaving the insurance companies to handle additional insurance packages (additional dental, homeopathic, acupuncture etc). I'm no commie, but universal health care has clear benefits, and if it's truly universal and socialised, it's better to let the state run it instead of a (in case of Dutch health insurance) dysfunctional market.