Health care reforms in the Netherlands

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Health care reforms in the Netherlands

• 1 July 2006
• Yvonne van Kemenade
• Albert Schweitzer hospital

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Content

• Features Dutch HC system
• Crucial problems?
• HC reforms 2005-2006
• Health Insurance Act
• Act on Contracting, Tariffs, Hospital Facility,
  Market Regulation (short)
• First Experiences
• Albert Schweitzer Hospital current policy
• Trends and uncertainties

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3. Feautures Dutch System

• 1. Three compartiments
• - Exceptional Medical Expenses Act
• - Health Insurance Act
• - Supplementary insurance
• 2. Private nature HC-organications
• 3. Private insurance system
• Transfer Medical Exp Act to HIA
• Social Support Act 2007

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Reforms in health care managed/regulated
competition

• Health care expenditure
• Fragmentation former situation
• More responsibilities to parties
• Competiton, effectivity en efficiency
• Competition within certain conditions
• Solidarity, universal access, quality

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Different possibilities in competition

• --
• ZBCs/private Topclinical care
• Planned elective care General practitioner
• Curative care SEH

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Submarkets curative care - 2005
Consumer
HC insurance market
HC providing market
(ZFW) (EMEA/AWBZ) (Wtz) (Wet MOOZ)
Government
Insurer
HC provider
HC purchase market
(WZV) (WTG) (ZFW)

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Submarkets curative care 2005/6
Consumer
HC insurance market
HC providing market
(HIA) (EMEA/AWBZ) (HCAllowances/Wet Zorgtoeslag)
HC Authority (WMG)
Insurance compan.
HC provider
HC puchaser market t
(WTZi) (WTG Expres) (HOZ)
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1. HCI ActChanges HC consumer

• Same conditions insured and insurers
• 1 compulsory health insurance
• Basic benefit package co-payments
• Functional claims
• Premium nominal (gt18year)
• incomedependent (via employer)
• HC allowance

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1. HCI Act consumer

• Free choice insurer
• Premium - quality
• choice of HC provider (contracted)
• Policy types Restitution/ Benefit in kind
• No claim
• Open enrollment
• Additional benefit package
• Free to change yearly

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1. HCI ActChanges insurers

• Mutual competition insurers
• Private insurers, nationwide
• Acceptation obliged for basic p.
• Responsible to provide care
• Differentiation on premiums forbidden
• Risk adjustment
• Freedom of contracting negotiation HC providers

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1. HCAChanges insurer

• Policies (not) contracted
• Attract/to hold on insured
• Having own organisations of HC
• Group insurance (collectivities)
• More competition - merges/ colloboration (HC
  authority)

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2. Law on changing contracting (Wet HOZ)

• Abolish standard contract conditions
• Red. restrictions foreign HC providers
• Free contracting insurers organisations
• HCI A/ZFW Restitution (no contract-obligation
  no WTG)

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3. HC Tariff Act Express (WTG Expres)

• Experiments possible
• Facilitating DRGs
• Reducing bureaucracy lt administrative
  processes/costs
• Reduce Fraud

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4. Law on hospital entitlement/facility (WTZi)

• 2 year sector-policy
• Regiovision
• Deregulate planning and building ( incl DRG)
• Possibility for profit
• Transparancy conditions

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5. HC market regulation Act (WMG)

• ZAio/CTG sector supervision
• (ZVW AWBZ, not WMO)
• Include WTG
• Stimulate competition
• - (not) free prices
• - benchmark competition
• - regulating contract-conditions
• Fair competition obuse position of power
• Monitoring

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Regulation Authority (hospitals)

• 2005/2006
• Excessive tarriffs
• Market force obuse
• Cross-subsidising
• Stimulating transparancy
• Informal sanctions

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First experiences (June 2006)

• Consumer mobility 20-25
• Most mobility group contracting
• Merger insurers 4 insurers 90 market
• Uninsured ?
• Market orientation

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• Parties (insurers and hospitals/ specialists,
  consumers) are positioning
• Contracting Costs Quality?
• Selective contracting?
• Insurer as provider...

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Albert Schweitzer hospital
The mergers
Municipal HospitalDordrecht 1957
Merwede Hospital 1986
Albert Schweitzer Hospital 1999
Municipal Hospital Sliedrecht 1957
Jacobus 1989
Drechtsteden Hospital 1995
Refaja 1958
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ASZ hospital

• Revenues 185 million euro
• Adherence 320.000 people
• 3.700 employees
• 200 medical specialists
• 85 physicians in training
• No. of operational bed 700
• One hospital 4 locations
• Close to Rotterdam (20 km)

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Organisation chart

• Unique dual management

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Policy ASz hospital

• Costs/revenues (DBCs/DRGs 10 free)
• Positioning HC market (competition or
  colloberation) horizontal/vertical
• Teaching hospital Partnerships with AMC,
  Erasmus MC and University of Utrecht
• Deregulation threats but also more possibilities
  innovations etc..

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• Strategic orientation (external markt,
  developments, prognoses, new providers, etc
  marketing intelligence) and anticipating
• Strategic choices (functions, costs..)
• Surplus value/Right to excist

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• Client-awareness (who are our clients, what
  choices do they make and what influences that
  choices ect)
• Health care governance
• professionalise supervision of hospitals

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Trends/uncertainties???

• Transparancy Indicators HC prestations
  (benchmarks year 2004 2005) Annual report
• (Selective) contracting ?
• Run some risk
• Client awareness and choice ?
• Competition ? (effectiveness, quality,
  efficiency)
• Marketforces and power parties??

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Conclusion-1

• The insurer
• The hospitals
• The consumers
• Much uncertainties, but also a lot of
  oppertunities

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Reforms European countries(Basic principles)

• Costs control GDP (expanding demand)
• Changing finance systems hospitals, physicians,
  pharmaceuticals, medical devices etc.
• More cost sharing, out of pocket payments
• Emphasis on efficiency en effectiveness
• Priority on ambulatory care

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European countries, trends

• Technology assessment, admission requirements
  devices etc.
• Transparency
• Invest in health data systems
• Monitor performance, using valid indicators and
  data and benchmarks

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Conclusion-2

• Health care in the Netherlands is moving towards
  a regulated market.
• The reforms and trends have the same basic
  principles as other European countries. But each
  country makes its own decisions because of
  differences in values, traditions, institutions.
• In the Netherlands, there is a lot to do the
  coming years and there are many uncerntainties..
• ..But also a lot of oppertunities..

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• YvanKemenade_at_wxs.nl