Presentatie Leers Augustus 2007 Tbv Chinese Delegation Jppc

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