Yvonne van Kemenade Health care reforms in the Netherlands 1 July 2006 Yvonne van Kemenade Albert Schweitzer hospital

Yvonne van KemenadeYvonne van Kemenade

Health care reforms in Health care reforms in the Netherlandsthe Netherlands

1 July 20061 July 2006


Albert Schweitzer hospitalAlbert Schweitzer hospital


ContentContent

Features Dutch HC systemFeatures Dutch HC system Crucial problems?Crucial problems? HC reforms 2005-2006HC reforms 2005-2006 Health Insurance ActHealth Insurance Act Act: on Contracting, Tariffs, Hospital Act: on Contracting, Tariffs, Hospital

Facility, Market Regulation (short)Facility, Market Regulation (short) First ExperiencesFirst Experiences Albert Schweitzer Hospital: current policyAlbert Schweitzer Hospital: current policy Trends and uncertaintiesTrends and uncertainties


3. Feautures Dutch System3. Feautures Dutch System

1. Three compartiments:1. Three compartiments:- Exceptional Medical Expenses Act- Exceptional Medical Expenses Act- Health Insurance Act- Health Insurance Act- Supplementary insurance- Supplementary insurance

2. Private nature HC-organications2. Private nature HC-organications3. Private insurance system3. Private insurance system

Transfer Medical Exp Act to HIATransfer Medical Exp Act to HIA Social Support Act 2007Social Support Act 2007


Reforms in health care: Reforms in health care: managed/regulated competitionmanaged/regulated competition

Health care expenditureHealth care expenditure Fragmentation former situationFragmentation former situation More responsibilities to partiesMore responsibilities to parties Competiton, effectivity en efficiencyCompetiton, effectivity en efficiency Competition within certain conditionsCompetition within certain conditions Solidarity, universal access, quality Solidarity, universal access, quality


Different possibilities in competition Different possibilities in competition

++++ ----

ZBC’s/privateZBC’s/private Topclinical careTopclinical care

Planned elective carePlanned elective care General General practitionerpractitioner

Curative careCurative care SEHSEH


Submarkets curative care - 2005Submarkets curative care - 2005

Consumer

InsurerHC provider

HC insurance marketHC providing market

HC purchase market

Government

(WZV)(WTG)(ZFW)

(ZFW) (EMEA/AWBZ)(Wtz)(Wet MOOZ)


Submarkets curative care 2005/6Submarkets curative care 2005/6

Consumer

Insurance compan.HC provider

HC insurance marketHC providing market

HC puchaser markett

HC Authority(WMG)

(WTZi)(WTG Expres)(HOZ)

(HIA) (EMEA/AWBZ)(HCAllowances/Wet Zorgtoeslag)


1. HCI Act1. HCI ActChanges HC consumerChanges HC consumer

Same conditions insured and insurersSame conditions insured and insurers 1 compulsory health insurance 1 compulsory health insurance Basic benefit package + co-Basic benefit package + co-

paymentspayments Functional claimsFunctional claims Premium: nominal (>18year) &Premium: nominal (>18year) &

incomedependent (via employer)incomedependent (via employer) HC allowanceHC allowance


1. HCI Act: consumer1. HCI Act: consumer

Free choice insurer: Free choice insurer: • Premium - quality Premium - quality • choice of HC provider (contracted)choice of HC provider (contracted)• Policy types: Restitution/ Benefit in kindPolicy types: Restitution/ Benefit in kind• No claimNo claim• Open enrollmentOpen enrollment• Additional benefit packageAdditional benefit package• Free to change yearlyFree to change yearly


1. HCI Act1. HCI ActChanges insurersChanges insurers

Mutual competition insurers Mutual competition insurers Private insurers, nationwidePrivate insurers, nationwide Acceptation obliged for basic p.Acceptation obliged for basic p. Responsible to provide careResponsible to provide care Differentiation on premiums forbiddenDifferentiation on premiums forbidden Risk adjustment Risk adjustment Freedom of contracting: negotiation Freedom of contracting: negotiation

HC providersHC providers


1. HCA1. HCAChanges insurerChanges insurer

Policies: (not) contracted Policies: (not) contracted Attract/to hold on insured Attract/to hold on insured Having own organisations of HCHaving own organisations of HC Group insurance (collectivities)Group insurance (collectivities) More competition - merges/ More competition - merges/

colloboration (HC authority)colloboration (HC authority)


2. Law on changing contracting 2. Law on changing contracting (Wet HOZ)(Wet HOZ)

Abolish standard contract conditionsAbolish standard contract conditions Red. restrictions foreign HC providersRed. restrictions foreign HC providers Free contracting insurers & Free contracting insurers &

organisations organisations HCI A/ZFW: Restitution (no contract-HCI A/ZFW: Restitution (no contract-

obligation & no WTG)obligation & no WTG)


3. HC Tariff Act Express 3. HC Tariff Act Express (WTG Expres)(WTG Expres)

Experiments possible Experiments possible Facilitating DRG’sFacilitating DRG’s Reducing bureaucracy & < Reducing bureaucracy & <

administrative processes/costsadministrative processes/costs Reduce Fraud Reduce Fraud


4. Law on hospital 4. Law on hospital entitlement/facility (WTZi)entitlement/facility (WTZi)

2 year sector-policy2 year sector-policy RegiovisionRegiovision Deregulate planning and building (& Deregulate planning and building (&

incl DRG)incl DRG) Possibility for profit Possibility for profit Transparancy conditions Transparancy conditions


5. HC market regulation Act 5. HC market regulation Act (WMG)(WMG)

ZAio/CTG: sector supervision ZAio/CTG: sector supervision (ZVW &AWBZ, not WMO)(ZVW &AWBZ, not WMO) Include WTGInclude WTG Stimulate competitionStimulate competition

- (not) free prices- (not) free prices- benchmark competition- benchmark competition- regulating contract-conditions- regulating contract-conditions

Fair competition: obuse position of powerFair competition: obuse position of power MonitoringMonitoring


Regulation Authority (hospitals)Regulation Authority (hospitals)

2005/20062005/2006

- Excessive tarriffsExcessive tarriffs- Market force – obuseMarket force – obuse- Cross-subsidisingCross-subsidising- Stimulating transparancyStimulating transparancy- Informal sanctionsInformal sanctions


First experiences First experiences (June 2006)(June 2006)

Consumer mobility 20-25%Consumer mobility 20-25% Most mobility: group contractingMost mobility: group contracting Merger insurers: 4 insurers 90% Merger insurers: 4 insurers 90%

marketmarket Uninsured: ?Uninsured: ? Market orientationMarket orientation


Parties (insurers and hospitals/ Parties (insurers and hospitals/ specialists, consumers) are specialists, consumers) are positioningpositioning

Contracting Costs & Quality? Contracting Costs & Quality? Selective contracting?Selective contracting? Insurer as provider...Insurer as provider...


Albert Schweitzer hospitalAlbert Schweitzer hospitalThe mergersThe mergers

Jacobus1989

Refaja1958

Municipal HospitalDordrecht1957

Municipal Hospital Sliedrecht1957

DrechtstedenHospital1995

MerwedeHospital 1986

Albert SchweitzerHospital1999


ASZ hospitalASZ hospital

Revenues: 185 million euro Revenues: 185 million euro Adherence: 320.000 peopleAdherence: 320.000 people 3.700 employees3.700 employees 200 medical specialists200 medical specialists 85 physicians in training85 physicians in training No. of operational bed 700No. of operational bed 700 One hospital: 4 locationsOne hospital: 4 locations Close to Rotterdam (20 km)Close to Rotterdam (20 km)


Organisation chartOrganisation chart

Unique dual managementUnique dual management


Policy ASz hospitalPolicy ASz hospital

Costs/revenues (DBC’s/DRG’s 10% free)Costs/revenues (DBC’s/DRG’s 10% free)

Positioning HC market (competition or Positioning HC market (competition or colloberation): horizontal/verticalcolloberation): horizontal/verticalTeaching hospital: Partnerships with AMC, Erasmus MC and Teaching hospital: Partnerships with AMC, Erasmus MC and University of UtrechtUniversity of Utrecht

Deregulation: threats but also more Deregulation: threats but also more possibilities innovations etc..possibilities innovations etc..


Strategic orientation (external markt, Strategic orientation (external markt, developments, prognoses, new developments, prognoses, new providers, etc… marketing providers, etc… marketing intelligence) and anticipatingintelligence) and anticipating

Strategic choices (functions, costs..)Strategic choices (functions, costs..) Surplus value/Right to excistSurplus value/Right to excist


Client-awareness (who are our Client-awareness (who are our clients, what choices do they make clients, what choices do they make and what influences that choices and what influences that choices ect…)ect…)

Health care governance:Health care governance:

professionalise supervision of professionalise supervision of hospitalshospitals


Trends/uncertainties???Trends/uncertainties???

Transparancy: Indicators HC prestations Transparancy: Indicators HC prestations (benchmarks year 2004 + 2005) Annual (benchmarks year 2004 + 2005) Annual reportreport

(Selective) contracting ?(Selective) contracting ? Run some riskRun some risk Client awareness and choice ?Client awareness and choice ? Competition ? (effectiveness, quality, Competition ? (effectiveness, quality,

efficiency)efficiency) Marketforces and power parties??Marketforces and power parties??


Conclusion-1Conclusion-1

The insurer …The insurer …

The hospitals…The hospitals…

The consumers…The consumers…

Much uncertainties, but also a lot of Much uncertainties, but also a lot of oppertunities… oppertunities…


Reforms European countriesReforms European countries(Basic principles)(Basic principles)

Costs control GDP % (expanding demand)Costs control GDP % (expanding demand) Changing finance systems hospitals, Changing finance systems hospitals,

physicians, pharmaceuticals, medical physicians, pharmaceuticals, medical devices etc.devices etc.

More cost sharing, out of pocket paymentsMore cost sharing, out of pocket payments Emphasis on efficiency en effectivenessEmphasis on efficiency en effectiveness Priority on ambulatory care Priority on ambulatory care


European countries, trendsEuropean countries, trends

Technology assessment, admission Technology assessment, admission requirements devices etc.requirements devices etc.

TransparencyTransparency Invest in health data systemsInvest in health data systems Monitor performance, using valid Monitor performance, using valid

indicators and data and benchmarksindicators and data and benchmarks


Conclusion-2Conclusion-2

Health care in the Netherlands is moving towards a Health care in the Netherlands is moving towards a regulated market.regulated market.

The reforms and trends have the same basic The reforms and trends have the same basic principles as other European countries. But eprinciples as other European countries. But each ach country makes its own decisions because of country makes its own decisions because of differences in values, traditions, institutions.differences in values, traditions, institutions.

In the Netherlands, there is a lot to do the coming In the Netherlands, there is a lot to do the coming years and there are many uncerntainties…..years and there are many uncerntainties…..

……..But also a lot of oppertunities..But also a lot of oppertunities....


[email protected]@wxs.nl

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Yvonne van Kemenade Health care reforms in the Netherlands 1 July 2006 Yvonne van Kemenade Albert Schweitzer hospital