maart

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ZNProviding a unified voice for the Dutch
health insurers

• Walter Annard
• Director Public Affairs

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Topics

• The health insurance system
• The health insurers market
• The trade association
• Main issues

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I International comparison
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The system

• Three main characteristics
• Dutch health care is private sector
• Accessibility guaranteed by layered system of
  insurances
• Managed competition

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Current system three compartments
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Long term care insurance

• Compulsory protection (Exceptional Medical
  Expenses Act) for all citizens
• Cover
• Benefits in kind, for some health care services
  sums of money
• Care for elderly, physically and/or mentally
  disabled people with chronical diseases,
  psychiatric patients
• Premium 13,45 over income per 1/1/2005

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Social health insurance (1)

• Compulsory insured
• Total number 10,1 mln. People, 2/3 population
• Wage limit (wage limit emplyees 2005 33.000
  euro)
• Benefits in kind
• Coverage general practitioner, hospital care,
  pharmaceutical care, obstetrics

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Social health insurance (2)

• Two-tier premium
• income related of 8,2 (employer 6,5 -
  employee 1,7
• Flat rate premium (individual insurers)approximate
  ly 360 euro per person per year based on
  commmunity rating
• Carried out by non-profit insurers (mutual funds)

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Private health insurance

• Voluntary protection
• Fee for service
• Flat rate premiums based on experience rating
• Cover parallel with social insurance
• Nominal premium, on average 147 euro per month
• 1/3 of population
• Carried out by profit en non-profit insurers
• Regulated by European Union law (directive)

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Supplementary insurance

• Voluntary insurance for everyone with a social
  and private insurance
• Coverage against costs of dental care for adults,
  physiotherapeutical care, cosmetic surgery,
  homeopathic medicines, etc.
• Offered both by social and private insurers

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Basic Health Insurance
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Characteristics I

• One health insurance for every citizen covering
  cure
• Private insurance (EU-legislation, for profit).
• Private.but with public guarantees (crown
  jewels)
• Mandatory enrollment/no risk selection
• Pooling

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Characteristics II

• Variaty in package (FFS/benefits in kind,
  possibility PPO)
• Mixed premium (2200 euro a year)
• Employer contribution
• Flat rate premium
• No claim (250 euro a year)
• Competition on basis premium, package, service,
  supplementary insurance
• For profit

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Flow of money Basic Health Insurance
Employer contribution 50
Employer
Pooling fund
Tax contribution 5
Government
Distribution
Individual compensation
Flat-rate premium 45
Insured
Insurer
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II The Market
1/3 population mandatory (EMEA) and private
(substitutive) insurance
2/3 population mandatory (EMEA, SHI) and
supplementary insurance
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The market

• Number of 59 health insurers in 2005
• 22 public insurers
• 37 private insurers
• Proces of mergers and strategic cooperation
  between and within groups of public and private
  insurers

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Positioning

• Transformation from executive body (health
  insurance funds) and indemnity insurer (private
  insurers) to health service company
• Three main tasks
• To insure risks
• To purchase health care providers (PPO, HMO)
• Offering services like prevention activities,
  waiting list mediation

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III The trade association ZN

• History
• Members
• Mission and main tasks
• Lobby

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History

• Polder model, Dutch expression voor civic
  society
• Zorgverzekeraars Nederland was founded in 1995

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Our members

• 37 members
• Regional versus national operating health
  insurers
• Solo versus multi branche
• Profit versus non profit

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Mission

• Realising favourable conditions in which the
  Dutch health insurers can work as entrepreneurs
  in health and security. We see it as a common
  interest to provide affordable access for each
  citizen to a high standard of care, sharing
  values as security, empathy and solidarity.

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Main tasks

• Advocacy of industry interests in The Hague and
  Brussels
• Spokesperson to media
• Representation in (international) government
  boards, committees and/or advisory bodies
• Research and policy development
• Support and services
• Code of conduct

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Lobby

• Monitoring developments in The Hague and Brussels
• Analysing issues
• Networking with government, politicians,
  journalists. Main rule good relationship with
  civil servants is essential
• Forming alliances with associations for health
  care providers, consumers, employers, etc
• Active use of publicity and management by speech
• Use of internet (www.zn.nl)

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Main issue

• Introduction basic health insurance