Reform of the Dutch Health Care System - Universal Coverage: One Size Does Not Fit All - Diana Monissen Director-General Curative Care Ministry of Health, Welfare and Sport The Netherlands

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: Rising demand and expectations: more elderly people, more chronic conditions More supply and technology Rising costs: from 10% to 15% in 2040 Shortage on human resources Empowerment of demand

Improve value for money Managed care and competition to improve outcome and maintain costs Create a sustainable health care system that is universal, affordable and of good quality Opportunities and responsibilities

The Dutch health insurance system Before health insurance reform After health insurance reform 2006 Description of healthcare system components Supplementary insurance Dental care Suppl. cover (drugs, physiotherapy,etc) Alternative medicine Vitality (health checks, health clubs) 20% costs Private supplementary insurance Public insurance Private insurance Basic insurance Hospital care (in- and outpatient) Pharmaceuticals Specialists and GP’s 80% costs Exceptional medical expenses act (AWBZ) Exceptional medical expenses act (AWBZ) Long-term care Care for mentally and physically disabled Home care (nursing) Total health expenses 2008 basic health insurance are estimated on 31 bn euro. Total health expenses EMEA 2008 are about 21,4 bn. Social support act (WMO) Social care and support

The solution: Health care will be more market driven 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

Cornerstones of the Dutch health insurance Every citizen required to have health insurance ‘Basic’ coverage defined by law Obligation to accept, community rating Risk adjustment for high risk patients Balanced financing

Risk equalization system 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 € 872 Income € 941 -/- € 63 Region € 98 -/- € 67 Pharmaceut. costgroup -/- € 315 -/- € 315 Diagnostic costgroup € 6202 -/- € 130 From REF € 7800 € 297

Overview of quality, insurance and market Consumers Health Care Inspectorate IGZ Healthcare Authority NZA Insurers Providers Healthcare Insurance Board CVZ

Lessons thus far Choice and mobility: awareness of possibility to move, need of transparency, dedicated health plans Uninsured and defaulters: number is low in comparison (<3%) but still a concern, new policy to enforce mandate Cost and quality: expenditure rising but controlled, growing number of contracts on performance

Health 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! Diana Monissen Director General Curative Care Ministry of Health, Welfare and Sport of The Netherlands dm.monissen@minvws.nl http://www.minvws.nl/en/themes/health-insurance-system