1. 1 oktober ’15 ZN ‘Providing a unified voice for the Dutch health insurers’ Walter Annard Director Public Affairs

2. 2 oktober ’15 Topics ■ The health insurance system ■ The health insurers market ■ The trade association ■ Main issues

3. 3 oktober ’15 Organisation and finance of health care system Insurer and Insurance premium Social insurance Austria France Belgium Luxembourg Private insurance Switzerland USA Mix private / social insurance Netherlands Germany Government and taxes Categorical Danmark Ireland Universal Portugal Greece Sweden Italy UK Canada Norway Finland I International comparison

4. 4 oktober ’15 The system ■ Three main characteristics: Dutch health care is private sector Accessibility guaranteed by layered system of insurances Managed competition

5. 5 oktober ’15 Current system: three compartments

6. 6 oktober ’15 Long term care insurance ■ Compulsory protection (Exceptional Medical Expenses Act) for all citizens ■ Cover: ● Benefits in kind, for some health care services sums of money ● Care for elderly, physically and/or mentally disabled people with chronical diseases, psychiatric patients ■ Premium: 13,45% over income per 1/1/2005

7. 7 oktober ’15 Social health insurance (1) ■ Compulsory insured ● Total number: 10,1 mln. People, 2/3 population ■ Wage limit (wage limit emplyees 2005: 33.000 euro) ■ Benefits in kind ■ Coverage: general practitioner, hospital care, pharmaceutical care, obstetrics

8. 8 oktober ’15 Social health insurance (2) ■ Two-tier premium income related of 8,2 % (employer 6,5% - employee: 1,7 % Flat rate premium (individual insurers)approximately 360 euro per person per year based on commmunity rating ■ Carried out by non-profit insurers (mutual funds)

9. 9 oktober ’15 Private health insurance ■ Voluntary protection Fee for service Flat rate premiums based on experience rating Cover parallel with social insurance ■ Nominal premium, on average 147 euro per month ■ 1/3 of population ■ Carried out by profit en non-profit insurers ■ Regulated by European Union law (directive)

10. 10 oktober ’15 Supplementary insurance ■ Voluntary insurance for everyone with a social and private insurance ■ Coverage against costs of dental care for adults, physiotherapeutical care, cosmetic surgery, homeopathic medicines, etc. ■ Offered both by social and private insurers

11. 11 oktober ’15 Basic Health Insurance

12. 12 oktober ’15 Characteristics I ■ One health insurance for every citizen covering cure ■ Private insurance (EU-legislation, for profit). ■ Private….but with public guarantees (‘crown jewels’): * Mandatory enrollment/no risk selection * Pooling

13. 13 oktober ’15 Characteristics II ■ Variaty in package (FFS/benefits in kind, possibility PPO) ■ Mixed premium (2200 euro a year) Employer contribution Flat rate premium ■ No claim (250 euro a year) ■ Competition on basis premium, package, service, supplementary insurance ■ For profit

14. 14 oktober ’15 Flow of money Basic Health Insurance Employer Government InsuredInsurer Pooling fund Individual compensation Employer contribution 50% Tax contribution 5% Flat-rate premium 45% Distribution

15. 15 oktober ’15 II The Market 2/3 population mandatory (EMEA, SHI) and supplementary insurance 1/3 population mandatory (EMEA) and private (substitutive) insurance

16. 16 oktober ’15 The market ■ Number of 59 health insurers in 2005: 22 public insurers 37 private insurers Proces of mergers and strategic cooperation between and within groups of public and private insurers

17. 17 oktober ’15 Positioning Transformation from executive body (health insurance funds) and indemnity insurer (private insurers) to ‘health service company’ Three main tasks: ■ To insure risks ■ To purchase health care providers (PPO, HMO) ■ Offering services like prevention activities, waiting list mediation

18. 18 oktober ’15 III The trade association ZN ■ History ■ Members ■ Mission and main tasks ■ Lobby

19. 19 oktober ’15 History ■ ‘Polder model’, Dutch expression voor civic society ■ Zorgverzekeraars Nederland was founded in 1995

20. 20 oktober ’15 Our members ■ 37 members ■ Regional versus national operating health insurers ■ Solo versus multi branche ■ Profit versus non profit

21. 21 oktober ’15 Mission ■ “Realising favourable conditions in which the Dutch health insurers can work as entrepreneurs in ‘health and security’. We see it as a common interest to provide affordable access for each citizen to a high standard of care, sharing values as: security, empathy and solidarity.

22. 22 oktober ’15 Main tasks ■ Advocacy of industry interests in The Hague and Brussels ■ Spokesperson to media ■ Representation in (international) government boards, committees and/or advisory bodies ■ Research and policy development ■ Support and services ■ Code of conduct

23. 23 oktober ’15 Lobby ■ Monitoring developments in The Hague and Brussels ■ Analysing issues ■ Networking with government, politicians, journalists. Main rule: good relationship with civil servants is essential ■ Forming alliances with associations for health care providers, consumers, employers, etc ■ Active use of publicity and management by speech ■ Use of internet (www.zn.nl)

24. 24 oktober ’15 Main issue ■ Introduction basic health insurance