The business reasons for international services

1. The business reasonsfor international services The reasoning why Pan-European data exchange in the Health Insurance Sector will be(come) beneficial Budapest, May 10th 2011 John Stevens CZ (Dutch Health Insurance Organization)

2. Reasoning for setting up a business: Not that complicated ! The supply market The demand market • His customers who: • have a need • are willing to pay for it My Grand Father’s proposition: € Selling price > Buying price

3. The NETC@RDS proposition: Indeed, no vegetables but ….. The supplymarket: The “demand market” • Insured/Patient’s needs: • medical problem to be solved • entitlement like at home • not being bored by forms, • dedicated cards, cash payment • Proposition 1*: • Online insurance verification, • providing confirmation of entitlement, enabled by: • - various portable documents like:(EHIC; • eCards, ID- and Social Security Cards) • automatic capture of data • The doctor wants: • doing his job • guarantee to get his money • no unfamiliar procedures • Proposition 2*: • Online eApproval, providing payment • guarantee • digital “EHIC-dataset” (PDF and XML) • Patient’s insurer wants: • satisfied customer • cost effective procedures: • . by preference national ID • . no calls for E111 • . no paper based reimbursement • Proposition 3*: • eBilling, providing all input for: • digital invoicing • automatic settlement of E125 • The national (Liaison)body wants: • no paper based invoices • no paper based copies of EHIC • no errors in data

4. Service proposition 1: Online Insurance verification, based on various portable documents Who benefits, and to what extend ? only 37% of EU citizens 37% = 190.000.000 EHIC’s Automatic data capture by OCR and/or SCR, currently operational for EHIC and eCards eEHIC) • 100% • no need for a • separate card € 200.000.000,00 yearly - Service experience - No additional stress - Feeling a real European - Time savings • - Satisfied customers • Cost savings • up to date insurance status

5. Service proposition 2: Online e Approval, providing payment guarantee and EHIC dataset Who benefits, and to what extend ? In case of no show EHIC: 2.557.000 calls for PRC • automatic update • patient file • EHIC dataset enabling • eBilling • - payment guarantee • no need to call • for a PRC • no need to pay • cash • no need to apply • for reimbursement € 22.000.000,00 yearly • - Service experience • No additional stress • Time (possibly cost) savings • Time savings • Focus on his job, rather • than being a bookkeeper - Satisfied customers - Time savings

6. Service proposition 3: eBilling, preventing from paper based invoicing Who benefits, and to what extend ? 22.600.000 invoices to be reimbursed • dataset enabling • eBilling • familiar/national • procedures - no longer copies of EHIC (and its dataset to be captured manually) - no longer paper based invoices (about 1 mln) to be transferred into E125 € 75.000.000,00 yearly - Satisfied customers - Time savings • Time savings • Time savings

7. In summary: the reasoning for providing international services is based on 4 business cases: Business cases no additional EHIC emission • Cost savings • not to apply • for: • EHIC • reimbursem. - eBilling - auto. update patient file - data capture reduction: - calls for PRC - requests for reimbursement eBilling • Time savings • Fraud prevention/ • cost containment No private tariffs not quantifiable • Improvement of • service quality - national ID - no cash - no calls - no stress Focus on job no disappointed customers no data errors >10 mln 200-300 mln Bottom line:

8. Balancing costs/benefits from Dutch perspective: Costs Benefits 40.000 EHIC-related invoices (EU citizens in NL) € 350.000,00 Annual costs for providing international services: € 155.000,00 25.000 EHIC-related invoices (NL citizens in EU/MS) € 220.000,00 BEP : 17.700 transactions 30.000 calls for PRC € 260.000,00 400.000 requests for reimbursement € 3.500.000,00 PM: 3.600.000 EHIC’s € 3.600.000,00

9. Although in the Netherlands we might apply another balance scale, I’m sure that … Costs Costs Benefits Benefits …your scale will demonstrate positive outcomes as well

10. More information: Report downloadable: http://www.netcards-project.com/web/bplan

12. To what extend the balance will tipp the scales in your country/region depends on: Your country • Starting position country . health infrastructure . online services . portal provider . business model . costs for international service to be calcula- ted as marginal costs • Entrepreneurship • HIO’s back offices connected • “Customers” (HIO’s) willing to pay for international services Fellow member State • Health infrastructure available? • HCP’s connected to infrastructure, and able to make use of online services • HCP’s willing to use the cross border service • European Commission • Willingness to allow Member States on voluntary basis to pilot with EHIC substitutes • Willingness to work towards mandatory online insurance verification • Encouraging MS’s Liaison bodies to accept downloaded EHIC dataset/PRC’s as payment guarantee • (to be provided in SED format)