Download Quality Improvement in Dutch Hospitals

Ministerie van Volksgezondheid, Welzijn en Sport
The Dutch Healthcare
Reform: Towards Private
Healthcare for All
General health information
• Total population: 16,2 mln.
• GDP per capita € 23,000
• Life expectancy at birth m/f (years): 75.8/80.7
Visit Dr. Hlavacka and delegation
Slovak Republic
• Healthy life expectancy at birth m/f (years): 68.7/71.1
Geert Jan Hamilton
Director of Legislation and Legal Affairs
Ministry of Health, Welfare and Sports
• Child mortality m/f (per 1000): 6/5
• Adult mortality m/f (per 1000): 97/66
• Total health expenditure per capita (Intl $): 2,255
• Total health expenditure as % of GDP: 8.1
(WHO 2004)
Ministerie van Volksgezondheid, Welzijn en Sport
Ministerie van Volksgezondheid, Welzijn en Sport
Ministerie van Volksgezondheid, Welzijn en Sport
Population in the Netherlands by municipality 1950 and 2000
Population in the Netherlands by age
and sex on January 1, 1850-2050
Tot. Exp. on health % GDP 1993 / 1994
Numb. physicians / nurses per 1,000 (WHO 1994)
OECD / World bank / WHO
Ministerie van Volksgezondheid, Welzijn en Sport
Ministerie van Volksgezondheid, Welzijn en Sport
10
Turkey
9
UK
1,6
8
Ireland
1,7
1
Luxembourg
7
5
6,5
2,1
Netherlands
6
0,9
9,7
2,5
9
Finland
2,8
Iceland
2,8
10,7
5
7
4
France
2,8
Denmark
2,8
Portugal
2,9
Sweden
3
Switzerland
3
3,7
3
8,3
2
2,7
Albania
Latvia
Romania
Turkey
Croatia
Ireland
Greece
Denmark
UK
Luxembourg
Spain
Sweden
Portugal
Western Europe
Israel
Norway
Iceland
Belgium
Italy
Germany
Finland
Netherlands
France
Austria
0
Switzerland
1
0
7,1
7,8
2
4
6
8
10
12
14
16
Three characteristics of
Dutch health care
• The mix of public and private finance
• The predominantly private character
of supply
• Sharing of responsibilities between
government, health insurers and
providers of care (pluralism)
Development of legislation
• Origin: private mutuality
• 1941: Obligatory health insurance for low
income employees
• 1966: Law on social insurance
• 1968: Law on exceptional medical benefits
• 1971: Law on provision of hospital care
(planning act)
• 1982: Law on tariffs in health care
• 1986: Law on access to private health
insurance
Ministerie van Volksgezondheid, Welzijn en Sport
Ministerie van Volksgezondheid, Welzijn en Sport
Three compartments
in dutch health care system
Laws of the ninetees
• Law on the medical contract (chapter
of Civil Code)
• Law on Medical Professions
• Law on Quality in Health Care
Institutions
• Law on Complaint Procedures
• Competition Law
Ι
Long term care (AWBZ)
Social
Health
insurance
ΙΙ
ΙΙΙ
cure
Private health
insurance
Additional care and cure
private complementary insurance
Ministerie van Volksgezondheid, Welzijn en Sport
Ministerie van Volksgezondheid, Welzijn en Sport
Financing health care
expenditures 2001 (€ 81
billion)
Financing health care
expenditures 2001 (€ 81
billion)
Curative somatic care
Own pocket /
other
6%
Exeptional
Medical
Expenses Act
38%
8%
2%
Drugs and aids/supplies
Government
5%
39%
22%
Handicapped
Private
Insurance
15%
Nursing
9%
Social health
Insurance
Ministerie van Volksgezondheid, Welzijn en Sport
36%
Mental health soc. Relief
8%
12%
Management and
controll
Health promotion
Ministerie van Volksgezondheid, Welzijn en Sport
Organisation
Ministry of Health, Welfare and Sport
Board of
health
insurance
Board of
hospital
buiding
Health insurers
Board of
tariffs
in health care
Providers
Patients/insurers
Ministerie van Volksgezondheid, Welzijn en Sport
Tensions/frictions
• Tensions between legal right to
benefits and measures of cost
containment
• Waitings lists
• Borderline bureaucracy between
public and private insurance
Ministerie van Volksgezondheid, Welzijn en Sport
Big reform on health
insurance; drivers:
• Desire to have a stronger demand focus
• Desire to have less government
interference (in planning and tarification)
• Renewed definition of responsibilities
• Dual system has led to a complicated
steering mechanism
• Ongoing borderline and solidarity issues
Ministerie van Volksgezondheid, Welzijn en Sport
Reforms in social health
insurance in the nineties
• Reintroduction of competition in
social health insurance
• Freedom of choice of the insured
• Abolition of the obligation of sickness
funds to contract all suppliers
• Growing role of competition law in
social health insurance
Ministerie van Volksgezondheid, Welzijn en Sport
Reforms on their way
• Less central steering; more local
responsibilities
• More private out patient clinics
• Radical reform of hospital financing:
from budget financing towards
payment for diagnosis treatment
combination (“DRG’s”)
Ministerie van Volksgezondheid, Welzijn en Sport
New basic insurance for
curative care (2006)
• New private insurance for all
• Obligation for citizens to buy health insurance
• Obligation for insurers to accept insured without risk
selection
• Legal description of entitlements
• Free choise of insurer; choise of policy (benefits in kind or
reimbursement; different deductibles)
• Fixed nominal premiums
• Employer contribution
• A legal system of risk adjustment
• State compensation for low income people
• No claim refund
Ministerie van Volksgezondheid, Welzijn en Sport
Money flow in private health insurance
ium
rem
ed p
relat
e
m
Inco
Insured person
Nominal premium
Copa
yme
nt
Central cash
fund
Risk adjusted budget
Health insurer
Fees, tariffs, budget
Health care
provider
Ministerie van Volksgezondheid, Welzijn en Sport
Adapting the European nonlife insurance directives?
• Complementary insurance in France
• Rocard resolution
• A directive for health insurances?
• Balancing internal market principles
and the European social model
• New Dutch health insurance opens up
market of health insurance.
Ministerie van Volksgezondheid, Welzijn en Sport
Compatibility with European
insurance directives?
•
•
•
•
Social security systems out scope of insurance directives
Commission-Belgium judgement of EC Court of Justice;
Article 54 of third insurance directive;
European Commission: Member State can adopt specific
legal measures to protect the general interest;
• Duty to accept; basic minimum cover; solidarity based
premiums (non discrimination); equalisation of risks:
measures that can be justified under art. 54.
Ministerie van Volksgezondheid, Welzijn en Sport