Centre for the history of health insurance, dept. Medical Humanities

1. Centre for the history of health insurance, dept. Medical Humanities Going private?Statutory health insurance, sickness funds and the development of private health insurance in the Netherlands 1910-1986R.A.A. Vonk

2. Centre for the history of health insurance, dept. Medical Humanities

3. Centre for the history of health insurance, dept. Medical Humanities - If and in what way sickness funds have influenced the private health insurance market during the period 1910 - 1986

4. Centre for the history of health insurance, dept. Medical Humanities • 1900 • Poor Law (no income) • Sickness fund insurance (low income) • Out of pocket payment (middle/high income)

5. Centre for the history of health insurance, dept. Medical Humanities 1910 – 1940 • ± 1910: private health insurers (comp. plans) • 1912: binding resolution NMG • 1910-1930: high failure rate and “malpractices” • 1930: hospital plans • Sickness funds as moral example

6. Centre for the history of health insurance, dept. Medical Humanities

7. Centre for the history of health insurance, dept. Medical Humanities 1941 – 1946 1941: Introduction of social health insurance - compulsory (wage earners) - voluntary (non wage earners) • SHI schemes and PHI separated by an income limit

8. Centre for the history of health insurance, dept. Medical Humanities • Sickness Fund Decree: repercussions • PHI-companies lose major part portfolio • Sickness funds start to offer suppl. insurance • Sickness fund prohibited to provide PHI

9. Centre for the history of health insurance, dept. Medical Humanities 1947-1969 • Expansion social health insurance (income limit) • 1947: Bovenbouwers (PHI related to sickness funds) • Sickness funds and private insurers against national health insurance • 1957: ANPZ-policy and VVBR risk-pool

10. Centre for the history of health insurance, dept. Medical Humanities 1947-1969 • 1962: KLOZ (umbrella org. private health insurers) • Plans to reform health care sector (BVV/AWZ) • Bovenbouwers and insurers join forces • 1967: NOZ risk-pool

11. Centre for the history of health insurance, dept. Medical Humanities

12. Centre for the history of health insurance, dept. Medical Humanities • 1971-1980 • No immediate threat National Health Insurance • Escalating risk segmentation / premium differentiation • Skimming voluntary social health insurance • Bovenbouwers apply entrepreneurial principles

13. Centre for the history of health insurance, dept. Medical Humanities • 1971-1985 • 1971: Zeven pijlers-plan • 1974: Restructuring effort • 1986: WTZ • Dissolving voluntary social health insurance • Socializing private health insurance • Standard policy • Compulsory acceptance • Fixed premium

14. Centre for the history of health insurance, dept. Medical Humanities Conclusions • Moral example • “socialization” through competition (1960’s) • SHI-principles enter PHI • Failing self regulation (1970’s) • PHI-principles enter SHI (bovenbouwers) • Government intervention (1980’s)

15. Thank you, for your attention