|Integrated Care for Elderly|
|Implemented in this survey?|
The policy proposal described in this report aims at containing the costs of public expenditures on health care by introducing deductibles in social health insurance and the AWBZ scheme. These deductibles especially affect the 65% of the population that is covered by the social health insurance, patients with low income and high risks or chronic diseases will be affected most severe.
The policy proposal described in this report aims at containing the costs of public expenditures on health care by introducing deductibles in social health insurance and the AWBZ scheme. These
deductibles especially affect the 65% of the population that is covered by the social health insurance, patients with low income and high risks or chronic diseases will be affected most severe.
In the Netherlands, health care finance is marked by a mixed system of social and private health insurance, both providing comprehensive coverage to different sections of the population.
The basic premium in the social insurance sickness funds consists of two parts: (1) a uniform income-related contribution - standardized across funds - paid from payroll, and (2) a community-rated premium - that may vary across funds - paid by the insured directly to the sickness fund. In addition, sickness funds sell supplementary insurance and for this they are completely free to determine coverage as well as premiums (although all sickness funds voluntarily charge community-rated premiums). For curative care (e.g. hospital care, GP and medical specialist services, prescription drugs etc.) about 65 percent of the population (people with earnings below a legally specified income level) are compulsorily insured by sickness funds.
Coverage is fully standardized and benefits are provided in kind. Provincial and municipal civil servants, accounting for about 5 percent of the population, are covered by specific mandatory health insurance schemes (also see survey number 01/2003: Integrated care/ care for the elderly).
The rest of the population relies on voluntary private insurance, and about 2 percent are uninsured. Private health insurance premiums are risk-rated and depend on the chosen degree of insurance cover. Private health insurers are obliged by the Health Insurance Access Act (WTZ) to offer a standardized policy at a legally determined premium to the elderly and other high-risk groups. Any losses that private health insurers incur on these regulated policies are compensated from a pool that is filled by mandatory cross-subsidies paid by all those privately insured.
A compulsory national health insurance scheme (AWBZ) covers long-term and mental health care. The benefits offered by the AWBZ comprise 45% of the total expenditures on health care. The scheme is financed by general taxation (10%), income-related contributions (80%), and income-related co-payments up to a certain income level (10%). The AWBZ is administered by regional care offices, which are mandated by sickness funds and private health insurance companies. Since they are fully retrospectively reimbursed for all medical expenses covered by the AWBZ, they bear no financial risk.
|Medienpräsenz||sehr gering||sehr hoch|
See for the political and economical background policy survey number 01/2003: "Attempts to introduce a national health insurance scheme with managed or regulated competition among insurers and providers (1987-2003)", reported by Erasmus University Rotterdam, Institute of Health Policy & Management the Netherlands.
During the period after the second purple government (1998-2002), cost containment more or less disappeared from the political agenda. The result was an expansive growth of health care expenditures.
The succeeding centre-right three-party coalition, including the new populist LPF Party, even proposed increasing the pace of liberalizing supply and price controls in order to provide incentives to reduce waiting lists. Due to an internal power struggle within the unstable LPF Party, the new government fell within three months of coming to office.
The new - current - centre-right coalition has put cost-containment back on the political agenda. The new Liberal Minister of Health, Mr. Hoogervorst, came to office under tough budget constraints set by the Ministry of Finance in order to combat an economic recession. Cost-containment was back on the political agenda.
A specific problem in social health insurance and the AWBZ scheme is the excessive demand for services. Since coverage is fully standardized and benefits are provided in kind and since the costs of care for any individual are spread across the pool of insured individuals and prices are distorted, individuals will have a strong tendency to over-consume health care, leading to excessively rising spending levels on health care. This is known as "moral hazard". Minister Hoogervorst now aims to tackle these problems of moral hazard by introducing deductibles in the social health insurance and the AWBZ scheme.
|Implemented in this survey?|
Necessary changes in both the ZFW (Social Health Insurance Act) and the AWBZ need to be in conformity with European legislation and are subject to the judgement of the European Court of Justice in Luxembourg.
The CVZ (Board for Health Insurances) is moderately positive about this reform. The CVZ warns however for increasing administration costs of the social health insurance scheme.
Indicators used for a sufficient implementation of deductibles are to be the results of the key monitor, which is yearly produced by the CVZ (Health Insurance Board). The key monitor contains results about the co-payment rules in home care.
Evaluations results are not available.
Implementation of deductibles in health care is scheduled for 2005.
Legislation has to be adapted. Especially the social health insurance act and the AWBZ have to be adapted.
Problems may appear from the ongoing process of European integration. European legislation must be the guide in formulating the new system in which a deductible is built in.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
Magazines: Zorgvisie & ZM-Magazine (all in Dutch)
Policy papers of the House of representatives of the States General (all in Dutch)
|Integrated Care for Elderly|
Process Stages: Umsetzung, Evaluation, Strategiepapier, Gesetzgebung, Idee, Pilotprojekt, Veränderung/Richtungswechsel
Jan-Kees Helderman / Anniek Peelen