The business reasons for international services The reasoning why Pan-European data exchange in the Health Insurance Sector will be(come) beneficial Budapest, May 10 th 2011 John Stevens CZ (Dutch Health Insurance Organization)

Reasoning for setting up a business: Not that complicated ! My Grand Father’s proposition: His customers who: - have a need - are willing to pay for it € Selling price > Buying price The supply marketThe demand market

The proposition: Indeed, no vegetables but ….. The “demand market” Insured/Patient’s needs: - medical problem to be solved - entitlement like at home - not being bored by forms, dedicated cards, cash payment Patient’s insurer wants: - satisfied customer - cost effective procedures:. by preference national ID. no calls for E111. no paper based reimbursement The doctor wants: - doing his job - guarantee to get his money - no unfamiliar procedures The national (Liaison)body wants: - no paper based invoices - no paper based copies of EHIC - no errors in data Proposition 3*: eBilling, providing all input for: - digital invoicing - automatic settlement of E125 The supply market: Proposition 1*: Online insurance verification, providing confirmation of entitlement, enabled by: - various portable documents like: (EHIC; eCards, ID- and Social Security Cards) - automatic capture of data Proposition 2*: Online eApproval, providing payment guarantee - digital “EHIC-dataset” (PDF and XML)

Service proposition 1: Online Insurance verification, based on various portable documents Who benefits, and to what extend ? only 37% of EU citizens -100% - no need for a separate card 37% = EHIC’s € ,00 yearly - Service experience - No additional stress - Feeling a real European - Satisfied customers - Cost savings - up to date insurance status Automatic data capture by OCR and/or SCR, currently operational for EHIC and eCards eEHIC) - Time savings

Service proposition 2: Online e Approval, providing payment guarantee and EHIC dataset Who benefits, and to what extend ? In case of no show EHIC: calls for PRC € ,00 yearly - Service experience - No additional stress - Time (possibly cost) savings - Satisfied customers - Time savings - no need to call for a PRC - no need to pay cash - no need to apply for reimbursement - automatic update patient file - EHIC dataset enabling eBilling - payment guarantee - Time savings - Focus on his job, rather than being a bookkeeper

Service proposition 3: eBilling, preventing from paper based invoicing Who benefits, and to what extend ? invoices to be reimbursed € ,00 yearly - Satisfied customers - Time savings - dataset enabling eBilling - familiar/national procedures - Time savings - no longer copies of EHIC (and its dataset to be captured manually) - no longer paper based invoices (about 1 mln) to be transferred into E125 - Time savings

In summary: the reasoning for providing international services is based on 4 business cases: no additional EHIC emission reduction: - calls for PRC - requests for reimbursement eBilling- eBilling - auto. update patient file - data capture Business cases - national ID - no cash - no calls - no stress Focus on jobno disappointed customers Bottom line: No private tariffs mln no data errors not to apply for: - EHIC - reimbursem. Cost savings Time savings Fraud prevention/ cost containment Improvement of service quality not quantifiable >10 mln

Benefits Costs Annual costs for providing international services: € , calls for PRC € , requests for reimbursement € ,00 PM: EHIC’s € , EHIC-related invoices (EU citizens in NL) € ,00 Balancing costs/benefits from Dutch perspective: BEP : transactions EHIC-related invoices (NL citizens in EU/MS) € ,00

Although in the Netherlands we might apply another balance scale, I’m sure that … Benefits Costs Benefits Costs …your scale will demonstrate positive outcomes as well

More information: Report downloadable:

To what extend the balance will tipp the scales in your country/region depends on: Your country Starting position country. health infrastructure. online services. portal provider. business model. costs for international service to be calcula- ted as marginal costs Entrepreneurship HIO’s back offices connected “Customers” (HIO’s) willing to pay for international services European Commission Willingness to allow Member States on voluntary basis to pilot with EHIC substitutes Willingness to work towards mandatory online insurance verification Encouraging MS’s Liaison bodies to accept downloaded EHIC dataset/PRC’s as payment guarantee (to be provided in SED format) Fellow member State Health infrastructure available? HCP’s connected to infrastructure, and able to make use of online services HCP’s willing to use the cross border service