Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE

192 Special Solidarity Fund KCE Reports 133
9.15.2 An introduction to the Dutch healthcare system
9.15.2.1 Who and what is covered?
The Dutch health insurance system can be divided in three components.
• Statutory Exceptional Medical Expenses Act scheme (Algemene Wet
Bijzondere Ziektekosten, AWBZ), covering a wide range of chronic and
mental healthcare services with an exceptionally high cost. All Dutch
residents are covered by the Act.
• Statutory health insurance, providing a standard benefits package, based
on the Health Insurance Act (Zorgverzekeringswet, 2006).
• Complementary health insurance, covering less vital healthcare services
that are not covered by the standard benefits package (dental care for
people above 16, alternative ways of treatment, etc.)
Since January 1, 2006, all residents or those paying income tax in the Netherlands are
required to purchase health insurance coverage. If not, they risk penalisation. Insurers
are legally required to provide a standard benefits package covering medical care;
hospitalization; dental care (up to the age of 18); medical aids; medicines; maternity
care, ambulance and patient transport services; paramedical care.
In addition to the statutory standard benefits package, most citizens also have
complementary private health insurance for specific services that are not covered by
the standard benefits package - for example dental care (>age 22) or alternative
treatments. In opposite to the statutory health insurance, insurers are not required to
accept applications for private health insurance and could refuse potential clients. As
most of the population purchase a mixture of complementary and supplementary
private health insurance from the same health insurers who provide statutory coverage,
the government is concerned about the potential for risk selection (premiums and
products of voluntary coverage are not regulated).
9.15.2.2 Cost-sharing
Insured people with the same policy pay a same flat-rate premium to their private health
insurer. Before 2007, an insured was eligible for a refund of €255 if they incurred no
health care costs. If they incurred less costs than €255, they received the difference at
the end of the year. This system, called ‘no claims bonus’ system, was abolished in 2007
and has been replaced by a system of deductibles. Every insured aged 18 and over must
pay the first €150 of any health care cost in a given year. Children are exempt from
cost-sharing. The government introduced the use of ‘health care allowances’ for low
income citizens if the average flat-rate premium is higher than 5% of their household
income.
9.15.2.3 Financing of the health system
The statutory health insurance system is financed by premiums (almost 50%), paid by
the insured to his health insurer, and by income-related contributions. Income-related
contributions are collected by the Government and distributed among insurers
following a risk-adjusted capitation formula. Because the complementary health
insurance system fully drives on market mechanisms (no premium regulation), the riskadjusted
capitation formula is not applicable to complementary health insurance.