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Diana Monissen Director-General Curative Care Ministry of Health, Welfare and Sport

Reform of the Dutch Health Care System - Universal Coverage: One Size Does Not Fit All -. Diana Monissen Director-General Curative Care Ministry of Health, Welfare and Sport The Netherlands. Agenda. 1. Need for change. 2. Value for money.

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Diana Monissen Director-General Curative Care Ministry of Health, Welfare and Sport

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  1. Reform of the Dutch Health Care System - Universal Coverage: One Size Does Not Fit All - Diana Monissen Director-General Curative Care Ministry of Health, Welfare and Sport The Netherlands

  2. Agenda 1. Need for change 2. Value for money 3. Dutch cornerstones to universal coverage 4. Three lessons so far 5. Outlook on reform

  3. Need for change • Urgency of change: • Rising demand and expectations: more elderly people, more chronic conditions • More supply and technology • Rising costs: from 10% to 15% in 2040 • Shortage on human resources • Empowerment of demand

  4. Improve value for money • Managed care and competition to improve outcome and maintain costs • Create a sustainable health care system that is universal, affordable and of good quality • Opportunities and responsibilities

  5. The Dutch health insurance system After health insurance reform 2006 Before health insurance reform Description of healthcare system components Supplementary insurance • Dental care • Suppl. cover (drugs, physiotherapy,etc) • Alternative medicine • Vitality (health checks, health clubs) 20% costs Private supplementary insurance Public insurance Private insurance Basic insurance • Hospital care (in- and outpatient) • Pharmaceuticals • Specialists and GP’s 80% costs • Long-term care • Care for mentally and physically disabled • Home care (nursing) Exceptional medical expenses act (AWBZ) Exceptional medical expenses act (AWBZ) Social support act (WMO) • Social care and support

  6. The solution: Health care will be more market driven Insured are free to choose and change insurance company Health care insurers compete on premium, quality and services Providing health care by contracting suppliers Health care providers compete on price and quality of health care

  7. Cornerstones of the Dutch health insurance • Every citizen required to have health insurance • ‘Basic’ coverage defined by law • Obligation to accept, community rating • Risk adjustment for high risk patients • Balanced financing

  8. Risk equalization system

  9. Insurers Consumers Health Care Inspectorate IGZ Healthcare Authority NZA Healthcare Insurance Board CVZ Overview of quality, insurance and market Providers

  10. Lessons thus far Choice and mobility: awareness of possibility to move, need of transparency, dedicated health plans Uninsured and defaulters: number is low in comparison (<3%) but still a concern, new policy to enforce mandate Cost and quality: expenditure rising but controlled, growing number of contracts on performance

  11. Health care reform • Often incremental approach is ok, but sometimes you really need a big step to get to the other side. • Communication is key. • Status quo is everyone’s second best. Reform hurts at least one party. • Give it time. Don’t pull out the tulip bulb every time to see if the roots have grown.

  12. Thank you! Diana Monissen Director General Curative Care Ministry of Health, Welfare and Sport of The Netherlands dm.monissen@minvws.nl http://www.minvws.nl/en/themes/health-insurance-system

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