Reform of the Dutch Health Care System Universal

Reform of the Dutch Health Care System - Universal Coverage: One Size Does Not Fit All - Diana Monissen Director-General Curative Care Ministry of Health, Welfare and Sport The Netherlands 1

Agenda 1. Need for change 2. Value for money 3. Dutch cornerstones to universal coverage 4. Three lessons so far 5. Outlook on reform 2

Need for change • Urgency of change: 1. Rising demand expectations: more elderly people, more chronic conditions 2. More supply and technology 3. Rising costs: from 10% to 15% in 2040 4. Shortage on human resources 5. Empowerment of demand 3

Improve value for money • • • Managed care and competition to improve outcome and maintain costs Create a sustainable health care system that is universal, affordable and of good quality Opportunities and responsibilities 4

The Dutch health insurance system Before health insurance reform Private supplementary insurance After health insurance reform 2006 Supplementary insurance Description of healthcare system components ■ ■ Dental care Suppl. cover (drugs, physiotherapy, etc) 20% costs Alternative medicine Vitality (health checks, health clubs) n Hospital care (in- and outpatient) Public insurance Private insurance Basic insurance 80% costs n Pharmaceuticals n Specialists and GP’s Exceptional medical expenses act (AWBZ) Social support act (WMO) n Long-term care n Care for mentally and physically disabled n Home care (nursing) n Social care and support 5

The solution: Health care will be more market driven 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 6

Cornerstones of the Dutch health insurance 1. Every citizen required to have health insurance 2. ‘Basic’ coverage defined by law 3. Obligation to accept, community rating 4. Risk adjustment for high risk patients 5. Balanced financing 7

Risk equalization system Ministerie van Volksgezondheid, Welzijn en Sport 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 € 872 Income € 941 -/- € 63 Region € 98 -/- € 315 Diagnostic costgroup € 6202 -/- € 130 From REF € 7800 € 297 Pharmaceut. costgroup -/- € 67 8

Overview of quality, insurance and market Ministerie van Volksgezondheid, Welzijn en Sport Consumers Health Care Inspectorate IGZ Healthcare Authority NZA Insurers Providers Healthcare Insurance Board CVZ 9

Lessons thus far Choice and mobility: awareness of possibility to move, need of transparency, dedicated health plans Uninsured and defaulters: number is low in comparison (<3%) but still a concern, new policy to enforce mandate Cost and quality: expenditure rising but controlled, growing number of contracts on performance 10

Health 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. 11

Thank you! Diana Monissen Director General Curative Care Ministry of Health, Welfare and Sport of The Netherlands dm. monissen@minvws. nl http: //www. minvws. nl/en/themes/health-insurance-system 12