Quality improvement and cost containment in the dutch health insurance system
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Quality improvement and cost containment in the Dutch health insurance system Wim Groot Maastricht University & Council for Public Health and Health Care in the Netherlands Washington, March 9, 2009 Aims of health insurance reforms in the Netherlands in 2006

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Quality improvement and cost containment in the dutch health insurance system l.jpg

Quality improvement and cost containment in the Dutch health insurance system

Wim Groot

Maastricht University & Council for Public Health and Health Care in the Netherlands

Washington, March 9, 2009


Aims of health insurance reforms in the netherlands in 2006 l.jpg
Aims of health insurance reforms in the Netherlands in 2006 insurance system

  • To combine universal coverage and competition

  • A more equal distribution of the costs of health care

  • To improve quality of care by improving transarancy and selective contracting


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Health insurance reforms in the Netherlands in 2006 insurance system

  • All residents are obliged to buy basic package of health insurance

  • Basic package includes: general practitioner, medical specialist care hospital care, prescription drugs, maternity care, obstetrics, technical aids and dental care for children


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Universal access insurance system

  • Insurers are obliged to accept every applicant

  • Community-rated premium regardless of expected claims or pre-existing conditions

  • Once a year individuals have the opportunity to switch health insurer


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Financing of health insurance insurance system

  • 50% of total health expenditures are financed by income-related contributions

  • These are put into Risk Equalization Fund (REF)

  • Insurers receive payment from REF based on risk profile of insured to create level playing field

  • Community-rated premiums cover 45% of total costs


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Cost to the consumer insurance system

  • Average insurance premium is appr. $1400 per year

  • Income related premium is 7%

  • There is a compulsory deductible of $200

  • Maximum voluntary deductible is $640

  • For care not in basic package there is voluntary supplementary insurance


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Access for all insurance system

  • Children below age of 18 are exempted for paying insurance premiums

  • Compensation for insurance costs for people with low income

  • 98% of population has basic package of health insurance


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Effects of health insurance reforms insurance system

  • Fierce price competition among insurers

  • Consolidation of health insurance market

  • Development of consumer collectives as countervailing power to insurers (through employer, union, patient group, etc.)

  • Coalitions of insurers and patient groups have emerged aimed to improve quality and patient-centred contracting of health care providers


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Incentives for cost control insurance system

  • Risk Equalization Fund (and obligation to accept every consumer) has eliminated adverse selection

  • Price competition has led to more focus on cost containment and losses for insurers

  • Focus on selective contracting to improve quality and lower costs (quality and efficiency go together)

  • Insurers have used market power to reduce costs of pharmaceuticals


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Conclusion: Health insurance reforms in the Netherlands has resulted in

  • Price competition on health insurance market

  • Incentive for health insurers towards cost containment

  • More attention for quality of care in contracting of health care


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