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Diana MonissenDiana MonissenDirector-General Curative CareMinistry of Health, Welfare and

SportThe Netherlands

Reform of the Dutch Health Care Reform of the Dutch Health Care SystemSystem

- Universal Coverage: One Size Does Not Fit All -

Agenda

1. Need for change

2. Value for money

3. Dutch cornerstones to universal coverage

4. Three lessons so far

5. Outlook on reform

Need for change

• Urgency of change:1. Rising demand and expectations:

more elderly people, more chronic conditions

2. More supply and technology3. Rising costs: from 10% to 15% in 2040 4. Shortage on human resources5. Empowerment of demand

Improve value for moneyImprove value for money

• Managed care and competition to Managed care and competition to improve outcome and maintain costsimprove outcome and maintain costs

• Create a sustainable health care Create a sustainable health care system that is universal, affordable system that is universal, affordable and of good qualityand of good quality

• Opportunities and responsibilitiesOpportunities and responsibilities

The Dutch health insurance system

Description of healthcare system components

Before health insurance reform

After health insurance reform

2006

Private supplementary

insurance

Private insurance

Public insurance

Exceptional medical expenses

act (AWBZ)

Supplementary insurance

Exceptional medical

expenses act (AWBZ)

Basic insurance

Social support act (WMO)

■ Dental care■ Suppl. cover (drugs, physiotherapy,etc)■ Alternative medicine■ Vitality (health checks, health clubs)

Hospital care (in- and outpatient)

Pharmaceuticals

Specialists and GP’s

Long-term care

Care for mentally and physically disabled

Home care (nursing)

Social care and support

20%costs

80%costs

Insured are free to choose and change insurance company

Health care insurers compete on premium, quality and services

Providing health care by contracting suppliers

Health care providers compete on price and quality of health care

The solution: Health care will be more market driven

Cornerstones of the Dutch Cornerstones of the Dutch health health insuranceinsurance

1. Every citizen required to have health insurance

2. ‘Basic’ coverage defined by law3. Obligation to accept,

community rating4. Risk adjustment for high risk

patients

5. Balanced financing

Ministerie van Volksgezondheid, Welzijn en Sport

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In €’s / yr

Women, 40, jobless with disability income

allowance, urban region, hospitalized

last year for ostéoarthrite

Man, 38 , employed, prosperous region, no

medication or hospitalization last year nor

any chronic disease

Age / gender € 934 € 872Income € 941 -/- € 63

Region € 98 -/- € 67Pharmaceut. costgroup -/- € 315 -/- € 315

Diagnostic costgroup € 6202 -/- € 130

From REF € 7800 €

297

Risk equalization system

Ministerie van Volksgezondheid, Welzijn en Sport

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Consumers

InsurersProviders

Overview of quality, insurance and market

Health Care Inspectorate IGZ

Healthcare Authority NZA

Healthcare Insurance Board CVZ

Lessons thus far

Uninsured and defaulters: number is low in comparison (<3%) but still a concern, new policy to enforce mandate

Choice and mobility: awareness of possibility to move, need of transparency, dedicated health plans

Cost and quality: expenditure rising but controlled, growing number of contracts on performance

Health care reformHealth care reform

• Often incremental approach is ok, but sometimes you really need a big step to get to the other side.

• Communication is key.

• Status quo is everyone’s second best. Reform hurts at least one party.

• Give it time. Don’t pull out the tulip bulb every time to see if the roots have grown.

Thank you!Thank you!

Diana MonissenDiana MonissenDirector General Curative CareDirector General Curative CareMinistry of Health, Welfare and Sport of The NetherlandsMinistry of Health, Welfare and Sport of The Netherlands

dm.monissen@minvws.nldm.monissen@minvws.nlhttp://www.minvws.nl/en/themes/health-insurance-system