1 oktober ’15 zn ‘providing a unified voice for the dutch health insurers’ walter annard...
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1 20 apr 2023
ZN‘Providing a unified voice for the
Dutch health insurers’
Walter Annard
Director Public Affairs
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2 20 apr 2023
Topics
■ The health insurance system■ The health insurers market■ The trade association■ Main issues
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3 20 apr 2023
Organisation and finance of health care system
Insurer and Insurance premium
Government and taxes
Social insuranceMix private / social
insurance
AustriaFranceBelgium
Luxembourg
NetherlandsGermany
Categorical Universal
DanmarkIreland
PortugalGreeceSweden
ItalyUK
CanadaNorwayFinland
Private insurance
SwitzerlandUSA
I International comparison
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4 20 apr 2023
The system
■ Three main characteristics:
• Dutch health care is private sector
• Accessibility guaranteed by layered system of insurances
• Managed competition
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5 20 apr 2023
Current system: three compartments
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6 20 apr 2023
Long term care insurance■ Compulsory protection (Exceptional Medical
Expenses Act) for all citizens
■ Cover:● Benefits in kind, for some health care services
sums of money● Care for elderly, physically and/or mentally
disabled people with chronical diseases, psychiatric patients
■ Premium: 13,45% over income per 1/1/2005
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7 20 apr 2023
Social health insurance (1)
■ Compulsory insured● Total number: 10,1 mln. People, 2/3
population
■ Wage limit (wage limit emplyees 2005: 33.000 euro)
■ Benefits in kind■ Coverage: general practitioner, hospital
care, pharmaceutical care, obstetrics
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8 20 apr 2023
Social health insurance (2)
■ Two-tier premium• income related of 8,2 % (employer 6,5%
- employee: 1,7 %• Flat rate premium (individual
insurers)approximately 360 euro per person per year based on commmunity rating
■ Carried out by non-profit insurers (mutual funds)
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9 20 apr 2023
Private health insurance■ Voluntary protection• Fee for service• Flat rate premiums based on experience rating• Cover parallel with social insurance ■ Nominal premium, on average 147 euro per
month ■ 1/3 of population■ Carried out by profit en non-profit insurers■ Regulated by European Union law (directive)
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10 20 apr 2023
Supplementary insurance
■ Voluntary insurance for everyone with a social and private insurance
■ Coverage against costs of dental care for adults, physiotherapeutical care, cosmetic surgery, homeopathic medicines, etc.
■ Offered both by social and private insurers
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11 20 apr 2023
Basic Health Insurance
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12 20 apr 2023
Characteristics I
■ One health insurance for every citizen covering cure
■ Private insurance (EU-legislation, for profit).
■ Private….but with public guarantees (‘crown jewels’):
* Mandatory enrollment/no risk selection* Pooling
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13 20 apr 2023
Characteristics II■ Variaty in package (FFS/benefits in kind,
possibility PPO)■ Mixed premium (2200 euro a year)
• Employer contribution• Flat rate premium
■ No claim (250 euro a year)■ Competition on basis premium, package,
service, supplementary insurance■ For profit
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14 20 apr 2023
Flow of money Basic Health Insurance
Employer
Government
Insured Insurer
Pooling fund
Individual compensation
Employer contribution 50%
Tax contribution 5%
Flat-rate premium 45%
Dis
tribu
tion
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15 20 apr 2023
II The Market
2/3 populationmandatory (EMEA, SHI)
and supplementary insurance
1/3 populationmandatory (EMEA)
and private (substitutive) insurance
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16 20 apr 2023
The market
■ Number of 59 health insurers in 2005:
• 22 public insurers
• 37 private insurers
• Proces of mergers and strategic cooperation between and within groups of public and private insurers
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17 20 apr 2023
PositioningTransformation from executive body (health
insurance funds) and indemnity insurer (private insurers) to ‘health service company’
Three main tasks:■ To insure risks■ To purchase health care providers (PPO,
HMO)■ Offering services like prevention activities,
waiting list mediation
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18 20 apr 2023
III The trade association ZN
■ History■ Members■ Mission and main tasks■ Lobby
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19 20 apr 2023
History
■ ‘Polder model’, Dutch expression voor civic society
■ Zorgverzekeraars Nederland was founded in 1995
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20 20 apr 2023
Our members
■ 37 members■ Regional versus national operating
health insurers ■ Solo versus multi branche■ Profit versus non profit
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21 20 apr 2023
Mission
■ “Realising favourable conditions in which the Dutch health insurers can work as entrepreneurs in ‘health and security’. We see it as a common interest to provide affordable access for each citizen to a high standard of care, sharing values as: security, empathy and solidarity.
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22 20 apr 2023
Main tasks
■ Advocacy of industry interests in The Hague and Brussels
■ Spokesperson to media■ Representation in (international) government
boards, committees and/or advisory bodies■ Research and policy development■ Support and services■ Code of conduct
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23 20 apr 2023
Lobby
■ Monitoring developments in The Hague and Brussels■ Analysing issues■ Networking with government, politicians, journalists.
Main rule: good relationship with civil servants is essential
■ Forming alliances with associations for health care providers, consumers, employers, etc
■ Active use of publicity and management by speech ■ Use of internet (www.zn.nl)
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24 20 apr 2023
Main issue
■ Introduction basic health insurance