Health care in the Netherlands
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Health care in the Netherlands is financed by a dual system.
Long-term treatments, especially those which involve (semi-)permanent hospitalization, and also disability costs such as wheelchairs, are covered by a a state-run mandatory insurance. This is laid down in the Algemene Wet Bijzondere Ziektekosten (AWBZ, see article in the Dutch Wikipedia), "general law on exceptional healthcare costs" which first came into effect in 1968.
For all regular (short-term) medical treatment, there is a system of obligatory health insurance, with private health insurance companies. These insurance companies are obliged to provide a package with a defined set of insured treatments [1].
This system came into effect in January 2006. For those who would otherwise have insufficient income, an extra government allowance is paid to make sure everyone can pay for their health care insurance. People are free to purchase additional packages from the insurance companies to cover additional treatments such as dental procedures and physiotherapy. These additional packages are optional.
A key feature of the Dutch system is that premiums are set at a flat rate for all purchasers regardless of health status or age. Risk variances between funds due to the different risks presented by individual policy holders are compensated through risk equalization and a common risk pool which makes it more attractive for insurers to attract risky clients. Funding for all short term health care is 50% from employers, and 45 percent from the insured person and 5% by the government. Children until age 18 are covered for free. Those on low incomes receive compensation to help them pay their insurance. Premiums paid by the insured are about 100 € per month with variation of about 5% between the various competing insurers.
Prior to 2006 (and since 1941) there were two separate systems of (short-term) health insurance: public and private. The public insurance system was executed by non-profit "health funds", and financed by premiums taken directly out of the wages (together with income taxes). Everyone earning less than a certain threshold income could make use of the public insurance system. However, anyone with income over that threshold was obliged to have private insurance instead.[2].
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[edit] Reform
The Netherlands has introduced a new system of health care insurance based on risk equalization through a risk equalization pool. In this way, a compulsory insurance package is available to all citizens at affordable cost without the need for the insured to be assessed for risk by the insurance company. Indeed health insurers are now willing to take on high risk individuals because they receive compensation for the higher risks [3].
A 2008 article in the journal Health Affairs suggested that the Dutch health system, which combines mandatory universal coverage with competing private health plans, could serve as a model for reform in the US.[4][5]
A video (in Dutch and English) is available which explains the reforms. Subtitles in English are available by clicking the 'T' control on the video control after clicking this link.
[edit] Insurance
The Netherlands has a dual-level system. All primary and curative care (i.e. the family doctor service and hospitals and clinics) is financed from private compulsory insurance. Long term care for the elderly, the dying, the long term mentally ill etc. is covered by social insurance funded from taxation. According to the WHO, the health care system in the Netherlands was 62% government funded and 38% privately funded as of 2004.[6]
Insurance companies must offer a core universal insurance package for the universal primary, curative care which includes the cost of all prescription medicines. They must do this at a fixed price for all. The same premium is paid whether young or old, healthy or sick. It is illegal in The Netherlands for insurers to refuse an application for health insurance, to impose special conditions (e.g. exclusions, deductables, co-pays etc or refuse to fund treatments which a doctor has determined to be medically necessary). The system is 50% financed from payroll taxes paid by employers to a fund controlled by the Health regulator. The government contributes an additional 5% to the regulator's fund. The remaining 45% is collected as premiums paid by the insured directly to the insurance company. Some employers negotiate bulk deals with health insurers and some even pay the employees' premiums as an employment benefit). All insurance companies receive additional funding from the regulator's fund. The regulator has sight of the claims made by policyholders and therefore can redistribute the funds its holds on the basis of relative claims made by policy holders. Thus insurers with high payouts will receive more from the regulator than those with low payouts. Thus insurance companies have no incentive to deter high cost individuals from taking insurance and are compensated if they have to pay out more than might be expected. Insurance companies compete with each other on price for the 45% direct premium part of the funding and try to negotiate deals with hospitals to keep costs low and quality high. The competition regulator is charged with checking for abuse of dominant market positions and the creation of cartels that act against the consumer interests. An insurance regulator ensures that all basic policies have identical coverage rules so that no person is medicially disadvantaged by his or her choice of insurer.
Hospitals in the Netherlands are also regulated and inspected but are mostly privately run and for profit, as are many of the insurance companies. Patients can choose where they want to be treated and have access to information on the internet about the performance and wait times at each hospital. Patients dissatisfied with their insurer and choice of hospital can cancel at any time but must make a new agreement with another insurer.
Insurance companies can offer additional services at extra cost over and above the universal system laid down by the regulator, e.g. for dental care. The standard monthly premium for health care paid by individual adults is about €100 per month. Persons on low incomes can get assistance from the government if they cannot afford these payments. Children under 18 are insured by the system at no additional cost to them or their families because the insurance company receives the cost of this from the regulator's fund.
[edit] References
- ^ http://www.minvws.nl/en/themes/health-insurance-system/ Ministry of Health, Welfare and Sport
- ^ World Health Orgamization: The WORLD HEALTH REPORT 2000
- ^ http://www.minvws.nl/en/themes/health-insurance-system/ Ministry of Health, Welfare and Sport
- ^ Wynand P.M.M. van de Ven and Frederik T. Schut, "UniversalMandatory Health Insurance In The Netherlands: AModel For The United States?," Health Affairs, Volume 27, Number 3, May/June 2008
- ^ Helen Garey and Deborah Lorber "Universal Mandatory Health Insurance in The Netherlands: A Model for the United States?," In the Literature, the Commonwealth Fund, May 13, 2008
- ^ World Health Organization Statistical Information System: Core Health Indicators
