1. 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

2. Agenda 1. Need for change 2. Value for money
3. Dutch cornerstones to universal coverage
4. Three lessons so far
5. Outlook on reform

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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 €
€ 872
Income €
-/- € 63
Region €
-/- € 67
Pharmaceut. costgroup
-/- €
-/- € 315
Diagnostic costgroup
€ 6202
-/- € 130
From REF
€ 7800
€ 297

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

10. 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

11. 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.

12. Thank you! Diana Monissen Director General Curative Care
Ministry of Health, Welfare and Sport of The Netherlands