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Ministry of Health and CZ Zorgverzekeringen TilburgM.Leers august 7 2007
the Dutch Health Care System
Jiangsu Provincial People's Congres
I The wealthier a country, the greater the lack of care will be found paradigma shift: from acute / infection towards chronicle /degenerative health expenditure: 14% GDP in 2040
22% of labour force in health care in 2025
II Performance health care is poor due to planning & financing system government intervention on prices and quantities led to:
- insufficient cost & quality awareness- lack of innovation - lack of incentives to perform well- waiting lists
III Stimulation is indispensable for proper performance countervailing power
• customer controls insurer• insurer controls healthcare provider• creating customer awareness that healthcare is costly
Different countries, same problems
Jiangsu Provincial People's Congres
Less government
More market forces
Moreresponsibility
and risk
Countervailing power
downscaling package
co-payments
output related (free) prices
deregulation on planning /prices
competition
more transparency
free choice providers
and insurers
Jiangsu Provincial People's Congres
The Health Care Reform 2006
Insured are free in their choice of
insurer; possibility to change every
yearHealth insurers
compete for insured on
premium, quality, service level
Health care providers
compete for contracts with
insurers on price & quality of care.
Jiangsu Provincial People's Congres
AWBZlong term care
1st compartment
public
2nd compartment
private
Health Insurance
Act
Public safeguard
s
Elements of
Competition
supplementaryinsurance
3rd compartment
private
The Health Care Reform 2006
Jiangsu Provincial People's Congres
Elements of competition in health insurance
• Competing private insurance companies (choice: profit or not for profit)
• Private insurance policies (compulsory)
• Policy variation is possible
- provision of care in kind or reimbursement- preferred providers, voluntary excess, service level
• Yearly free choice between health insurers for citizens
• Insurer is free to set nominal premium
Jiangsu Provincial People's Congres
Public safeguards in private insurance
•Under jurisdiction of European social law)
•Guarantees for insurant:
- Government defines coverage (basic package)- Tax reimbursement to guarantee pay ability
- Insurance company is obliged to accept all - No distinction in premium for a policy- Insurers guarantee the provision of care
•Ex ante risk equalization system
Jiangsu Provincial People's Congres
FLOW OF FUNDS
Government
Insurants
Risk equali-zation fund
Health Insurers
Care providers
Health Care Allowance
Nominal prem
ium
Income related contribution
Risk adjusted contri-bution
Bills & payments
Jiangsu Provincial People's Congres
Example Risk equalization
In euro’s a year
A woman aged 40, disability benefit,
living in urban area, last year
hospitalization for osteoarthritis
A working man aged 38, living in a good area, last year no
medication nor any hospitalization/chronic
diseasesDemographics
934 872
Source of income
941 -/- 63
Region 98 -/- 67
Pharmaceutical cost group
-/- 315 -/- 315
Diagnosis cost group
6.202 -/- 130
FROM FUND
7.800 297
Jiangsu Provincial People's Congres
Results so farPositive Negative
• Strong competition
• Lower premiums than expected
• Active switching by consumers
• Stronger position patient groups
• Administrative problems
• Unhappy providers – new financing systems
• Debate on income consequences
• Accumulation of innovations
Jiangsu Provincial People's Congres
Topics for the near future
•Path of liberalisation continued in what tempo ?
•Can insurers “lead” their clients? Degree of preferred providers, health plans
•Prevention, lifestyle
•Focus on transparency, performance measurement, patient empowerment
•Non-payers, uninsured
•Concentration (mergers)
Jiangsu Provincial People's Congres
Many changes, in health care emotions remain !!
the digital world
more risks and doubts
technology rules the waves
transparency matters
full of vitalityborderless
challenging
entrepreneurship