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

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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 This system, called ‘no claims bonus’ system, was abolished in 2007 and has been replaced by a system of deductibles.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.
KCE Reports 133 Special Solidarity Fund 193 Figure 21: Financing of the health insurance system (Statutory health insurance system) Source: Christelijke Mutualiteit (CM), Gezondheidssystemen in Europa, Ziekteverzekering en gezondheidszorgen in Nederland, maart 2008 In 2005, public sources of finance accounted for 65,7 % of total health expenditure, a percentage that has risen to 78% in 2006. In 2005, private health insurance accounted for 20,1% of total health expenditure, a proportion that had fallen to about 7% in 2006. 9.15.2.4 The organization of healthcare provision: Figure 22: Involved parties in the Dutch healthcare system Source: own analysis
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Optimalisatie van de werkingsprocessen van het Bijzonder ... - KCE

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