presentatie leers augustus 2007 tbv chinese delegation jppc
TRANSCRIPT
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Ministry of Health and CZ Zorgverzekeringen TilburgM.Leers august 7 2007
the Dutch Health Care System
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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
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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
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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.
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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
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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
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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
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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
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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
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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
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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)
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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