How Insurers are Compensated by Government and/or Insurance Premiums for Extra Health Risks in the Netherlands
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1 How Insurers are Compensated by Government and/or Insurance Premiums for Extra Health Risks in the Netherlands Enne Osinga Cancun, 16 March 2002
2 Overview presentation History Compulsory protection Voluntary protection Setting prices and charges for health insurance
3 History Roots Social Health Insurance Funds/Private Insurance Legislation 41, 66, 68, 89, 94 New role health insurance
4 Numbers (1996) Total population life expectancy at birth (fem.) 80,4 life expectancy at birth (male) 74,7 health exp./bbp 8,6 public health exp./tot health exp. 72,1
5 Compulsory protection Organisation financing population covered health care covered providers of health care role of mutual health funds principal reforms underway
6 Organisation home Private (37%, norm al care /cure) Zfw (63% norm al care/cure) Awbz (100% pop covered long term care m ental care and cure
7 Financing (1): ( 1999; bilj. Dfl) AWBZ 26,6 (37%) ZFW 25,9 (36%) private insurance 10,5 (15%) government 3,4 (5%) direct payments 4,8 (7%)
8 Financing (2): procedures AWBZ: collected with income tax =>central fund => regional care offices ZFW: funds have taken a financial risk: (1) income related contributions => General fund =>risk adjusted payment to fund (av. 90%) (2) nominal premium (av. 10%)
9 Financing (3): risk adjusted payment Parameters: age gender disability region
10 Population covered AWBZ: entire population ZFW: people with income under statutory level (2001: Dfl ) Private: civil servants + people with income > Dfl
11 Health care covered (1): AWBZ Long term care and Care which is difficult to insure against in the private sector (mental, care for handicapped, home care)
12 Health care covered (2): ZFW and private Normal necessary care: medical and surgical treatment dental care pharmaceutical hospital ambulance etc.
13 Health care covered (3): luxury Free market for luxury care: dental care for adults class-level stay in hospitals alternative medical treatments
14 Extent of compulsory cover Benefits of kind system: patients do not receive bills and out of pocket payments are uncommon
15 Providers of health care General practitioners ( huisarts ) fulfil gatekeepers role ZFW/AWBZ work with associated providers: they need a contract with the health insurance fund
16 Role of mutual health funds Social health Insurance Act (ZFW): health insurance funds are the only bodies authorised to administer compulsory health insurance non profit organisation managed in line to the wishes of those insured properly carry out the tasks
17 Principal reforms underway (?) Discussion about: National insurance for long term care Dual system of public and private insurance for basic medical care, incl. hospital Voluntary additional insurance for less necessary care, incl. dental care.
18 Voluntary protection The private health insurance market types of voluntary protection
19 The private health insurance market 15% of health care spending (Dfl. 10,5 bilj) competitive private insurance companies free to refuse clients except for Standard Packet Policy. Nominal premiums, often age related fee for service for provider reimbursement
20 Types of voluntary protection (1) All persons who are not insured under the ZFW or the public servants schemes are free to insure themselves on the private market
21 Types of voluntary protection(2) Medical Insurance Access Act (WTZ) for bad risks: all insurance companies are required to offer a policy to any individual who meets statutory criteria coverage is similar to the ZFW premium Dfl 2880 (65-) and Dfl 2650 (65+) the financial gap between revenues and expenditures under the SPP scheme is subsidised by the premiums paid by private policy holders
22 Setting prices and charges for health insurance Medical fees Synthetic material
23 Medical fees (1) Guiding principles AWBZ/ZFW: services in kind => contracts with health providers, regarding quality volume and price of care,
24 Medical fees(2) Fixing procedure Standard contracts, negotiated at national level National health Tariffs Act (WTG): insurers and providers negotiate guidelines and tariffs It is forbidden to charge tariffs without a statutory WTGbasis
25 Market for insurance companies (mln people) Achmea 2,7 CZ 1,7 VGZ 1,7 Amicon/RZG 1,7 AGIS 1,7 OZ/DSW/SR/A foortse 1,0 Unive 0,6 others 5,5
26 Questions and discussion home
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