Diana Monissen Director-General Curative Care Ministry of Health, Welfare and Sport
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Transcript of Diana Monissen Director-General Curative Care Ministry of Health, Welfare and Sport
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Diana MonissenDiana MonissenDirector-General Curative CareMinistry of Health, Welfare and
SportThe Netherlands
Reform of the Dutch Health Care Reform of the Dutch Health Care SystemSystem
- Universal Coverage: One Size Does Not Fit All -
Agenda
1. Need for change
2. Value for money
3. Dutch cornerstones to universal coverage
4. Three lessons so far
5. Outlook on reform
Need for change
• Urgency of change:1. Rising demand and expectations:
more elderly people, more chronic conditions
2. More supply and technology3. Rising costs: from 10% to 15% in 2040 4. Shortage on human resources5. Empowerment of demand
Improve value for moneyImprove value for money
• Managed care and competition to Managed care and competition to improve outcome and maintain costsimprove outcome and maintain costs
• Create a sustainable health care Create a sustainable health care system that is universal, affordable system that is universal, affordable and of good qualityand of good quality
• Opportunities and responsibilitiesOpportunities and responsibilities
The Dutch health insurance system
Description of healthcare system components
Before health insurance reform
After health insurance reform
2006
Private supplementary
insurance
Private insurance
Public insurance
Exceptional medical expenses
act (AWBZ)
Supplementary insurance
Exceptional medical
expenses act (AWBZ)
Basic insurance
Social support act (WMO)
■ Dental care■ Suppl. cover (drugs, physiotherapy,etc)■ Alternative medicine■ Vitality (health checks, health clubs)
Hospital care (in- and outpatient)
Pharmaceuticals
Specialists and GP’s
Long-term care
Care for mentally and physically disabled
Home care (nursing)
Social care and support
20%costs
80%costs
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
The solution: Health care will be more market driven
Cornerstones of the Dutch Cornerstones of the Dutch health health insuranceinsurance
1. Every citizen required to have health insurance
2. ‘Basic’ coverage defined by law3. Obligation to accept,
community rating4. Risk adjustment for high risk
patients
5. Balanced financing
Ministerie van Volksgezondheid, Welzijn en Sport
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In €’s / yr
Women, 40, jobless with disability income
allowance, urban region, hospitalized
last year for ostéoarthrite
Man, 38 , employed, prosperous region, no
medication or hospitalization last year nor
any chronic disease
Age / gender € 934 € 872Income € 941 -/- € 63
Region € 98 -/- € 67Pharmaceut. costgroup -/- € 315 -/- € 315
Diagnostic costgroup € 6202 -/- € 130
From REF € 7800 €
297
Risk equalization system
Ministerie van Volksgezondheid, Welzijn en Sport
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Consumers
InsurersProviders
Overview of quality, insurance and market
Health Care Inspectorate IGZ
Healthcare Authority NZA
Healthcare Insurance Board CVZ
Lessons thus far
Uninsured and defaulters: number is low in comparison (<3%) but still a concern, new policy to enforce mandate
Choice and mobility: awareness of possibility to move, need of transparency, dedicated health plans
Cost and quality: expenditure rising but controlled, growing number of contracts on performance
Health care reformHealth 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.
Thank you!Thank you!
Diana MonissenDiana MonissenDirector General Curative CareDirector General Curative CareMinistry of Health, Welfare and Sport of The NetherlandsMinistry of Health, Welfare and Sport of The Netherlands
[email protected]@minvws.nlhttp://www.minvws.nl/en/themes/health-insurance-system