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Regulated Competition in Healthcare Systems: Theory & Practice

Erasmus University Rotterdam via Coursera


In this MOOC you will learn about the theory and practice of 'regulated competition' (also known as 'managed competition') in healthcare systems. Many countries have implemented or consider implementation of regulated competition in healthcare. Examples include Australia, Belgium, Chile, Colombia, Germany, Ireland, Israel, The Netherlands, Switzerland and the United States. After completing this MOOC, you will be able to explain how regulated competition (in theory) promotes affordability, accessibility and efficiency of healthcare. Moreover, you will be able to explain why (in practice) successful implementation of regulated competition is very complex and often requires difficult trade-offs between policy objectives. We think this MOOC is highly valuable to any student, researcher or professional interested in healthcare system reform and design. Specific topics in this MOOC include a typology of healthcare systems, the economics of healthcare markets, theory and preconditions of regulated competition, risk adjustment and risk selection in health insurance, competition policy and provider payment.


  • Introduction and overview
    • In this module you will be introduced to the teachers involved in this MOOC and you will get an overview of the topics covered by this MOOC. Moreover, you will be asked to briefly introduce yourself. Have fun!
  • Why government intervention is necessary & waves of health care reform
    • In this module you will learn why government intervention in health care is necessary and how governments have intervened in the past century. You will learn that in high income countries three waves of government intervention in health care can be distinguished. Enjoy!
  • Market & government failure in healthcare
    • In this module you will learn that, particularly in health care, markets and governments are both far from perfect. The key challenge for market-based health system reform is therefore: how to navigate between market failure and government failure? As a start, you will learn some important lessons that should be taken into account when considering the introduction or strengthening of competition for healthcare provision. Enjoy!
  • Theory of regulated competition in healthcare systems
    • In this module you will learn about the model of regulated competition in healthcare systems. More specifically, you will learn what this model looks like and how it can help to simultaneously achieve affordability and efficiency. Have fun!
  • Preconditions for achieving efficiency & affordability in competitive health care markets
    • This module will introduce you to ten specific preconditions for achieving efficiency and affordability in competitive healthcare markets. For each precondition, you will learn what the consequences could be if this precondition is not fulfilled. In addition, you will learn to use the preconditions to evaluate the progress of the implementation of regulated competition. Good luck and have fun!
  • Ongoing reforms: premium regulation, risk equalization & risk sharing in health insurance markets
    • Social health insurance markets typically include premium regulation to promote affordability of health insurance for people with expensive medical conditions. A side-effect of premium regulation is that it confronts consumers and insurers with incentives for risk selection. In this module you will learn about typical forms of risk selection and their welfare effects. Moreover, you will learn about tools for the regulator to mitigate selection problems. Have fun!
  • Ongoing reforms: competition regulation in health care
    • In this module the focus is on effective competition regulation as an important precondition for achieving efficiency in competitive healthcare markets. You will first learn about the basic principles of this type of regulation, after which you will learn about three key issues regarding competition regulation in healthcare. These issues are: (1) hospital merger control; (2) insurer monopsony power; and (3) the potential trade-off between integration, coordination and the use minimum volume standards on the one hand and competition on the other. Good luck and have fun!
  • Ongoing reforms: provider payment in healthcare systems
    • In other videos about the preconditions for regulated competition, you’ve learned that in addition to consumers and insurers, providers of care should also be stimulated to spend resources wisely. Clearly, the extent to which this is the case depends on the way in which providers are paid for their services. This module therefore focuses on provider payment systems, and specifically on the design thereof. The core of the module consists of 7 videos divided over 3 lessons: (1) What drives provider payment reform? (2) Provider payment incentives & reform: what does the theory say? And (3) Value-based payment methods: types, design and effects. In contrast to the first lesson, lessons 2 and 3 start with a short introduction which you should read before you begin. Have fun!
  • Key takeaways & farewell
    • Congratulations, you are about to complete this MOOC! By now, you should be able to explain the model of regulated competition in healthcare including its background, principles and preconditions for success.
      In this final module we summarize the primary takeaways from this MOOC and say goodbye.

Taught by

Erik Schut, Richard van Kleef, Marco Varkevisser, Wynand van de Ven and Frank Eijkenaar


4.8 rating at Coursera based on 28 ratings

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