Innovation in European healthcare – what can Sweden learn? - LIF

The healthcare system is based on three independent
markets: insurance, commissioning and provision
Government
(regulation and supervision)
Health insurance
market
Insuree/
patient
First compartment
Insurers
Healthcare
provision
market
Healthcare
purchasing market
Providers
AWBZ: Obligatory national insurance for long-term
and unaffordable care
Second compartment
Zvw: Obligatory Basic insurance for essential curative
care
Third compartment
Supplementary insurance: Voluntary insurance,
range of cover
• Three compartments:
– 1st compartment: Long-term care (Exeptional Medical Expenses Act -
AWBZ / compulsory; contribution is 12,55% of taxable income)
– 2nd compartment: Curative care (Basic health insurance – Zvw;
mandatory)
– 3nd compartment: Supplementary care: (additional voluntary health
insurance VHI)
• The standard package (basisverzekering/basic medical care - Zvw)
is defined by the govermnment and generally covers:
– hospital care
– medication
– rehabilitation
– medical care by specialists, GPs and midwives
– dental help for persons younger than 22
– therapists, such as speech therapists and dieticians
– mental health care
– maternity care
– necessary medical help during a holiday or business trip abroad,
worldwide
• The insured can choose between three types of insurance policies:
– policy in kind: the insurance company concludes sufficient contracts with
health care suppliers in order to deliver health care. The insurance
company pays the bill directly to the health care supplier.
– restitution policy: the insured chooses the health care supplier himself
and pays the bills, after which the health insurance company reimburses
the insured (deductibles 100-500€)
– combination policy: part of the bill is paid by the insurance company
and the rest is paid by the insured
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