Money talks: Untangling the dynamics between banks, health insurers and healthcare organizations in the context of a regulated market

Banks and health insurers are vital to Dutch healthcare. Banks provide capital to healthcare organizations and health insurers purchase and reimburse care. There is, however, limited understanding of how these parties fulfill their roles and the consequences of their actions. This dissertation therefore explores the roles, dynamics, and practices between banks, health insurers, and healthcare organizations.

The findings show that international regulations and system reforms have significantly increased the influence of banks and health insurers. While the role of banks is seldom questioned, health insurers face legitimacy issues and strained relationships with healthcare organizations. The growing financial influence of banks and health insurers has also shifted governance practices in healthcare towards managing financial risks. Healthcare organizations have been compelled to professionalize financially, while banks also transfer financial risks to them. Finally, this dissertation highlights that when healthcare organizations deal with financial distress, banks and health insurers are significantly able to determine where and how care is delivered.

This dissertation warns for financial interests overshadowing other essential values in the healthcare system. Additionally, it emphasizes the need for healthcare actors, banks, and health insurers to gain a deeper understanding of each other’s roles and interests, hold one another accountable for their social responsibilities, and demonstrate long-term commitment to addressing future challenges.