New trends in private health care insurance in Belgium

Transcription

1 New trends in private health care insurance in Belgium

2 Contents 1. The Belgian health care insurance system in a nutshell 2. New developments in the complementary health care insurance market 26/04/2004 2

3 1.1. A generalised and generous social insurance Generalised social insurance covering up to 78% of total health care expenses (budget 2004 : 16,3 bn EUR) Employees : inpatient and outpatient care Self-employed : essentially inpatient care (this difference will disappear in the near future due to harmonisation reforms) Based on a price list defining the tariffs, the level of the legal reimbursement and the co-payment of the patient Supplements can however be added by the provider Time-gap between recognition and reimbursement Complementary social protection via Maximum Bill on copayments for low incomes (450 EUR) 26/04/2004 3

4 1.2. State controlled, but privately executed Organised by a governmental institution (RIZIV/INAMI) Sickness funds 12% Basically financed with social security contributions (85%) and completed with government subsidies (15%) 15% 29% 44% Executed by private nonprofit organisations (sickness funds) Christian Independant Socialist Other 26/04/2004 4

5 1.3. Actual scope of private health insurance Complementing social insurance covering co-payments, supplements and not yet legally reimbursed medical items Private insurance : limited importance wrt total health cost, but growing at a rate of 14% pa ( ) Not insured expenses mostly related to ambulatory care Total health expenses Not insured 18% Insured 4% Legal 78% Assuralia (2002) 26/04/2004 5

6 1.4. Actual scope of private health Insurance Wide-spread cover for inpatient care (in % of Belgian inhabitants) 30% via group insurance 10% via individual insurance 20% via sickness funds Insurance market of outpatient care is quite undeveloped because of fiscal barriers for employer sponsored plans and inefficient administrative processes not an adequate value proposition 26/04/2004 6

7 Contents 1. The Belgian health care insurance in a nutshell 2. New developments in the complementary health care insurance market 26/04/2004 7

8 2.1. Towards more private insurance % of GDP 25 Forecast Budget-GAP Legal Insur. 6,64% Gap Other Assuralia (2002) Total health expenditures increase from 9% to 19% GDP 26/04/2004 8

9 2.1. with a layer system Private insurers are conscious of their role as a partner in health care insurance Process of increased benefits in social insurance for unhealthy and low incomes already ongoing : maximum bill and higher reimbursement of chronic diseases Budgetary constraints lead to an increase of the uninsured market Private insurers will have to deal with access to insurance 26/04/2004 9

10 2.2. Towards more regulation. No specific regulation for health care insurance Upcoming regulation to guarantee A life-time health insurance continuity when leaving a group insurance and life-time contracts in individual insurance Access to an affordable health insurance (inpatient care) non-applicability of selection at entry in group insurance access to individual healthcare insurance Limited impact of pre-existing conditions 26/04/

11 2.2.. proposal of private insurers Proposal of private insurers (inpatient care) Guarantee access for a standard cover (excluding the private room) With a maximum premium amount Organise a solidarity mechanism for uninsurable risks between insurers 26/04/

12 2.3. Towards customer responsibility Segmentation The darker the more expensive for inpatient care Two main solutions a geographical premium segmentation or a behaviour driven reimbursement segmentation 26/04/

13 2.4. Towards more service Most insurers recently adopted TPP-systems for inpatient care Medi-Assistance : based on the concept of assistance MediCard, Assurcard : based on the concept of a credit card TPP-systems generally increase healthcare costs At this stage, the impact on claims cost is not yet quantified 26/04/

14 2.5. Towards a level playing field Sickness funds also offer complementary insurances in competition with private insurers Insurance regulations are not applicable Advantageous tax legislation The Belgian courts judged that sickness funds are operating on the market as far as complementary insurance is concerned that a different legal framework is not in contradiction with the principle of equal treatment wrt Belgian legislation The question is whether these judgements are compatible with European legislation : illegal government aid and insurance directives 26/04/

15 Conclusion A turnaround for complementary private healthcare insurance in Belgium As a valuable partner for the government In a competitive customer-focused environment 26/04/