Risk-adjusted funding of health insurers in The Netherlands Seminar on Risk-adjusted funding and equalization

1. Risk-adjusted funding of health insurers in The NetherlandsSeminar on Risk-adjusted funding and equalization Jan Bultman Lead Health Specialist World Bank Moscow December 20, 2004

2. Conditions • Sharply defined health benefits package • Functioning complaints/grievance procedures • Consensus about health care delivery • Competing insurers and functioning anti-cartel agency • No risk-adjusted contributions • Acceptance of every insured, regardless of health • Adequate administration (incl. data collection and transfer • Sophisticated health management information system

3. Conditions II • Adequate privacy protection of insured • Adequate protection of sensitive insurers data • Adequate insight in expenditures/insured • Adequate administration of insured • Functioning oversight/audit system • Reliable and transparent process • All actors act as agreed • Regular adjustment of parameter values

4. Variation in total expenditures per insured for 21 SF’s in percentage of the average expenditures for all SF’s in ’98 and in ‘03

5. Variation in costs for GP’sbetween 21 SF’s in 2003

6. Variation in costs fordrugs between 21 SF’s in 2003

7. Variation in costs formedical supplies/aids for handicapped between 21 SF’s in 2003

8. Market concentration SF’s1996 and 2003Source: CVZ: Zorg in cijfers

9. Total expenditures per insured 2003Brown: menYellow: women

10. Expenditures/insured 20031= 1 Euro