Ministry of Health and CZ Zorgverzekeringen Tilburg M.Leers  august 7 2007 the Dutch  Health Care   System
I  The wealthier a country, the greater the lack of care will be found     paradigma shift: from acute / infection towards...
Less  government More  market forces More responsibility  and risk Countervailing power downscaling package co-payments ou...
The Health Care Reform 2006 Insured are free in their choice of insurer; possibility to change every year Health insurers ...
AWBZ long term care 1st compartment public 2nd compartment private Health  Insurance  Act Public safeguards Elements of Co...
Elements of competition in health insurance  <ul><li>Competing private insurance companies    (choice: profit or not for p...
Public safeguards in private insurance <ul><li>Under jurisdiction of European social law) </li></ul><ul><li>Guarantees for...
FLOW OF FUNDS   Health  Care Allowance Nominal premium Income related contribution   Risk adjusted contri-bution Bills & p...
Example Risk equalization 297 7.800 FROM FUND -/- 130 6.202 Diagnosis cost group -/- 315 -/- 315 Pharmaceutical cost group...
Results so far Positive  Negative   <ul><li>Strong competition </li></ul><ul><li>Lower premiums than expected </li></ul><u...
Topics for the near future <ul><li>Path of liberalisation continued in what tempo ?  </li></ul><ul><li>Can insurers “lead”...
Many changes, in health care emotions remain !!   the digital world more risks and doubts technology rules the waves trans...
Upcoming SlideShare
Loading in...5
×

Presentatie Leers Augustus 2007 Tbv Chinese Delegation Jppc

388

Published on

Published in: Economy & Finance
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
388
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
2
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • Presentatie Leers Augustus 2007 Tbv Chinese Delegation Jppc

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

      Clipping is a handy way to collect important slides you want to go back to later.

    ×