1. Going private? Statutory health insurance, sickness funds and the development of private health insurance in the Netherlands 1910-1986 R.A.A. Vonk Centre for the history of health insurance, dept. Medical Humanities

3. -If and in what way sickness funds have influenced the private health insurance market during the period 1910 - 1986

4. Centre for the history of health insurance, dept. Medical Humanities 1900 -Poor Law (no income) -Sickness fund insurance (low income) -Out of pocket payment (middle/high income)

5. 1910 – 1940 -± 1910: private health insurers (comp. plans) -1912: binding resolution NMG -1910-1930: high failure rate and “malpractices” -1930: hospital plans -Sickness funds as moral example Centre for the history of health insurance, dept. Medical Humanities

7. 1941 – 1946 1941: Introduction of social health insurance - compulsory (wage earners) - voluntary (non wage earners) -SHI schemes and PHI separated by an income limit Centre for the history of health insurance, dept. Medical Humanities

8. Sickness Fund Decree: repercussions -PHI-companies lose major part portfolio -Sickness funds start to offer suppl. insurance -Sickness fund prohibited to provide PHI Centre for the history of health insurance, dept. Medical Humanities

9. 1947-1969 -Expansion social health insurance (income limit) -1947: Bovenbouwers (PHI related to sickness funds) -Sickness funds and private insurers against national health insurance -1957: ANPZ-policy and VVBR risk-pool Centre for the history of health insurance, dept. Medical Humanities

10. 1947-1969 -1962: KLOZ (umbrella org. private health insurers) -Plans to reform health care sector (BVV/AWZ) -Bovenbouwers and insurers join forces -1967: NOZ risk-pool Centre for the history of health insurance, dept. Medical Humanities

12. 1971-1980 -No immediate threat National Health Insurance -Escalating risk segmentation / premium differentiation -Skimming voluntary social health insurance -Bovenbouwers apply entrepreneurial principles Centre for the history of health insurance, dept. Medical Humanities

13. 1971-1985 -1971: Zeven pijlers-plan -1974: Restructuring effort -1986: WTZ -Dissolving voluntary social health insurance -Socializing private health insurance -Standard policy -Compulsory acceptance -Fixed premium Centre for the history of health insurance, dept. Medical Humanities

14. Conclusions - Moral example - “socialization” through competition (1960’s) - SHI-principles enter PHI - Failing self regulation(1970’s) - PHI-principles enter SHI (bovenbouwers) - Government intervention (1980’s)

15. Thank you, for your attention