Open Access Open Badges Research article

Acceptance of selective contracting: the role of trust in the health insurer

Romy E Bes1*, Sonja Wendel1, Emile C Curfs2, Peter P Groenewegen1 and Judith D de Jong1

Author Affiliations

1 NIVEL (Netherlands institute for health services research), Otterstraat 118 – 124, 3513, CR Utrecht, The Netherlands

2 Open University, Valkenburgerweg 177, 6419, AT Heerlen, The Netherlands

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BMC Health Services Research 2013, 13:375  doi:10.1186/1472-6963-13-375

Published: 2 October 2013



In a demand oriented health care system based on managed competition, health insurers have incentives to become prudent buyers of care on behalf of their enrolees. They are allowed to selectively contract care providers. This is supposed to stimulate competition between care providers and both increase the quality of care and contain costs in the health care system. However, health insurers are reluctant to implement selective contracting; they believe their enrolees will not accept this. One reason, insurers believe, is that enrolees do not trust their health insurer. However, this has never been studied. This paper aims to study the role played by enrolees’ trust in the health insurer on their acceptance of selective contracting.


An online survey was conducted among 4,422 people insured through a large Dutch health insurance company. Trust in the health insurer, trust in the purchasing strategy of the health insurer and acceptance of selective contracting were measured using multiple item scales. A regression model was constructed to analyse the results.


Trust in the health insurer turned out to be an important prerequisite for the acceptance of selective contracting among their enrolees. The association of trust in the purchasing strategy of the health insurer with acceptance of selective contracting is stronger for older people than younger people. Furthermore, it was found that men and healthier people accepted selective contracting by their health insurer more readily. This was also true for younger people with a low level of trust in their health insurer.


This study provides insight into factors that influence people’s acceptance of selective contracting by their health insurer. This may help health insurers to implement selective contracting in a way their enrolees will accept and, thus, help systems of managed competition to develop.

Health insurer; Trust; Managed competition; Selective contracting