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Health Insurance Exchanges in Switzerland and the Netherlands Offer Five Key Lessons for the Operations of U.S. Exchanges


Switzerland, Netherlands

The Issue

Health reforms in Switzerland and the Netherlands created new insurance markets that are similar to the state and federally operated health insurance exchanges, or marketplaces, scheduled to launch in the United States in 2014. Commonwealth Fund–supported researchers reviewed these countries’ experiences and offer lessons for the U.S. rollout.

What the Study Found

The authors identified the following important lessons for U.S. efforts to achieving high enrollment, improved outcomes, and lower costs in the new insurance marketplaces:

  • Tax penalties and fines will not be enough to persuade all individuals who are eligible for insurance coverage to enroll. Policymakers must learn about the barriers to enrollment and experiment with approaches to increase insurance enrollment and consumers’ awareness of subsidies.
  • Insurers will need bargaining power similar to what providers have in negotiating prices and improving the value of services.
  • To become prudent purchasers of health services, insurers and consumers must both have meaningful information about providers’ costs and quality of care. 


Since implementing health reform, Switzerland and the Netherlands have continued to work toward improving managed competition and addressing the unintended effects of their changes. Similarly, U.S. policymakers, the authors say, will need to conduct ongoing analyses of all the insurance marketplaces "to learn what works best to create incentives for efficiency."

Publication Details

Publication Date: April 8, 2013
Author: Katherine Swartz, Ewout van Ginneken and Philip Van der Wees
Summary Writer: Naomi Freundlich
Citation: E. van Ginneken, K. Swartz, and P. Van der Wees, "Health Insurance Exchanges in Switzerland and the Netherlands Offer Five Key Lessons for the Operations of U.S. Exchanges," Health Affairs, April 2013 32(4):744–52.


Professor of Health Economics, Harvard School of Public Health