Health insurers had insufficient incentives because of the still prevailing substantial ex post compensations and a lack of adequate instruments because of remaining government regulation of prices, supply and entry in various sectors. These problems were further compounded by a lack of an adequate system of product classification (DBCs) and a lack of reliable and publicly available quality information (performance indicators) due to insufficient patient level data and an inadequate information infrastructure (OECD 2010b, Klazinga etal., The latter is explicitly formulated as keeping public health care expenditure within an annual growth rate of 3 lA per cent.