Public Private Healthcare System The Netherlands

Transcription

1 1 Joint Colloquium of the IACA, PBSS and IAAHS Sections of the International Actuarial Association Westin Copley Place Hotel, Boston, U.S.A May 2008 Public Private Healthcare System The Netherlands Jeroen Breen Watson Wyatt The Netherlands

2 2 Some figures Population (2007) Surface km2 Density 394,3 / km2 (no 26 out of 231)

3 3 Agenda Introduction Looking back at the former Dutch Healthcare System Background to current Dutch Healthcare System The current market Free market within the Healthcare system Current & future challenges Questions / debate

4 4 Former Dutch Healthcare system (till 2005) Both public and private medical care insurances Three compartments: Non insurable risks : public / social security (AWBZ) More common curatieve dual system: Lower incomes Higher incomes Public (ZFW) Private Supplementary care Private 2003: Total costs: 58 billion AWBZ: 35% Other: 65%

5 Former Dutch Healthcare system (till 2005) 5 Wealthy 1/3 Income Moderate Near Poor Private Health Insurance AWBZ non-insurable Risk Public/private Poor Public Health Insurance 2/3 Young Working Ages Retired Age

6 Demographic development 0-20 // // Dutch Population by age Bron: CBS / rivm 100% 90% % 70% 60% 50% % 30% 20% 10% % : age 0-20 age age :

7 7 Healthcare cost by age/person Healthcare Costs by age ( ) 2003 figures Average

8 Development Healthcare costs by inhabitant 8 Dutch Healthcare Costs by inhabitant ( ) medical inflation 3,1%, general inflation 0,0% Costs by inhabitant ( )

9 9 Different medical inflations Increase of Dutch Healthcare costs Different medical inflations (general inflation 0,0% ) 8,00 7,00 6,00 5,00 4,00 3,00 2,00 1,00 0, medical inflation 3,1% medical inflation 3,6% medical inflation 4,1%

10 10 Need for change Heavy increase of the costs for healthcare Healthcare market not based on performance Inefficient system No (real) free market

11 11 Quality Efficiency - Costs Equal standard of quality costs efficiency

12 New Dutch Healtcare system (as of 1/1/2006) 12 A basic healthcare insurance (the basisverzekering) compulsory for all residents Provided through private insurers, but operates within the overall public health framework The cover provided under the basic insurance has been determined by the government and reimburses the costs of the main parts of people s healthcare needs The standard package does not reimburse all healthcare expenses, so people can choose to supplement their basic health insurance policy

13 New Dutch Healtcare system (as of 1/1/2006) 13 While the government has indicated an average cost across the Dutch population of providing the standard package at around 1,100 a year, insurers can set their own premiums They are not however allowed to apply medical selection, so no-one can be excluded All applicants must be charged the same premium (regardless of age, sex, health status etc) People can choose individually for supplementary health insurance People can also change insurer each year.

14 New Dutch Healtcare system (as of 1/1/2006) 14 Wealthy Income Moderate Near Poor Basic healthcare insurance ( basisverzekering ) Public / private Supplementary healthcare AWBZ non-insurable Risk Public/private Insurers have to accept everybody private Poor Young Working Ages Retired Age

15 15 Challenging market for insurers Compulsory acceptance Premium differentiation based on age or health is not permitted Risk and claims settlement To compensate the insurer for the less healthy risks in their portfolios, the government will operate a risk and claims settlement (risk equalisation) system Settlement delay Year 2006 is not settled yet Year 2007 is not settled yet

16 16 Future developments Stimulate free market thinking & acting Make use of techniques in other branches, like Retention (Motor) Capital funding / pay-as-you-go system (Retirement) Get rid of budgeting methods but use methods based on performance Increase the free market possibilities in hospitals but Always beware of the social component within Health (solidarity)

17 17 Joint Colloquium of the IACA, PBSS and IAAHS Sections of the International Actuarial Association Westin Copley Place Hotel, Boston, U.S.A May 2008 Public Private Healthcare System The Netherlands Jeroen Breen Watson Wyatt The Netherlands

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