The new health care system in the Netherlands

The new health care system in the Netherlands

Solidarity, efficiency and value for the patient. (Use the T-button in the player for english subtitles)

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  >> Voice over: The new health care system in the Netherlands was implemented following decades of discussion.

  >> Martin van Rijn (Director-General Ministry of Health, Welfare and Sport): Most Western countries, actually most countries in the world will be confronted in the next ten years with rising costs due to an aging population and technological advances. The game plan to control health care costs the coming years is to lower costs per product unit.

  >> Voice over: In 2005 13% of the total population in The Netherlands consisted of senior citizens. This percentage will increase in 2040 till 23 %. The Dutch care system existed since the second World War and was in urgent need of updating.
  For many years there was a fragmented system with compulsory social insurance for 65% of the population and private health care insurance for 35% of the population. The method of insurance depended for example on someone’s work situation, income, age and state of health. Now there is new standard insurance for all.

  >> Martin van Rijn: The government played a major role in health care. lt determined the rates, what had to be covered by insurance who was responsible for what. Now more of these decisions are made by the parties involved:
  lnsurers, care providers and patients.

  >> Mike Leers (CEO CZ Health Care Insurance): The important thing is that now everyone plays by the same rules. There's no more national health, no more private insurance. No longer are people divided into two categories.

  >> Voice over: One of the key elements of the new care system is the obligation for insurers to accept patients. This leads to risk-solidarity.

  >> Mike Leers: lt is socially irresponsible and unacceptable if insurers were to screen out undesirables that apply. Between healthy people and people in poor health. Whether they are young or old, healthy or ill it doesn't matter. They are all equal. There will be no difference in premium, and no surcharges on premiums. So you are not excluded if you are ill or given a higher premium based on age. That's basically at the heart of risk solidarity.

  >> Voice over: Despite the acceptance obligation, health insurers could be tempted to seek to avoid less healthy clients. Therefore the government has created a safetynet of risk equalization. Insurers are entitled to compensationfor expensive customers.

  >> Martin van Rijn: Every insurer gets an allowance from the equalization fund. An insurer with many high-risk clients gets a higher allowance than one with less high-risk clients. We look at medication use rates, the number of claims and hospitalization. Therefore insurers don't need to do risk assessments. That's an important social condition of our system.

  >> Hanneke Snellen (Director Dutch Arthritis Patient League): The advantage is that patients with chronic illnesses on medication are welcomed by insurance companies. lt becomes interesting to attract these clients as well.

  >> Voice over: The new care system will push for higher standards for insurers as well as care providers in terms of quality and costs. Care providers will have to work in a more performance oriented way but will also have more opportunities to distinguish themselves.

  >> Claudia Zuiderwijk-Jacobs (Chairman of the Board Ter-Gooi Hospitals): The system was based on an equality principle meaning hospitals and care providers offered the same services. Now hospitals will get reputations based on an expertise in oncology or in non-urgent surgery. Based on the information on Web sites or brochures, patients can see that this hospital is good for that problem and there's no waiting list.

  >> Mike Leers: ln the new health care system, patients can go abroad. ln other words, our national health insurance offers world coverage. That's quite unique, compared to other systems.

  >> Voice over: In this care system patients will get greater responsibilities. The system provides them with incentives for cost-consciousness. Therefore they will carefully select the insurance that combines coverage of the costs of the best of care and a competitive price.

  >> Mike Leers: We negotiate deals with care providers for millions of clients for good care at competitive prices. And if you are not happy with your insurer, you switch. Send in a notice card, that's all it takes.

  >> Martin van Rijn: lf they have to work to get clients they will have to offer quality at the lowest possible price. The same applies to care providers. lf they want contracts with insurance companies they will have to offer good products at the lowest possible price.

  >> Claudia Zuiderwijk-Jacobs: The new system means that you keep a sharp eye on your operating costs to determine your market prices. And you are more aware of your customers' needs.

  >> Mike Leers: That's healthy competition, and that's better for consumers.

  >> Hanneke Snellen: lnsurers will have to listen to the needs of patients. We already notice that.

  >> Martin van Rijn: lf you want people to have more responsibility and more choice to get better care, and not have a top-down decision-making process you need two very important rules. One is: guarantee good quality care. The Health lnspection ensures that quality is guaranteed in the Netherlands. And you need a market referee who ensures that negotiations between insurers and care providers are honest. To avoid creating monopolies and power blocks.

  >> Voice over: How do we pay for the care system; The care system is financed by three parties. The employer will pay an income-related contribution of 50% that will flow into the Health Insurance fund. The government will contribute 5% which will also flow into this fund. The insured will pay a nominal premium for their standard insurance directly to the health insurer (45%). Children up to the age of 18 years are insured for free. People who have difficulty paying the fixed premium owing to low income can apply for a care allowance. In this way the insurance is affordable for everybody.

  >>Mike Leers: lf your premium is too high in relation to your income you are eligible for a care allowance to compensate the high costs in relation to your income.

  >> Voice over: The key elements of the new care system are: new standard insurance for all;
  Citizens can change insurer every year;
  Insurers compete for the business of the insured;
  Customers and insurers stimulate suppliers to provide better quality;
  Compensation is available for people with low incomes.

  >> Martin van Rijn: These reforms deal with curative care: first-line care, hospital care short-term mental health care and medication. ln the Netherlands we also have a classic social insurance for long-term health care. We are looking to create more leeway for insurers and care providers to give them both more leeway and more responsibility.

  >> Hanneke Snellen: You can tell the Dutch health system has changed and people are talking about it. lt's a good beginning because it couldn't go on the old way, it wasn't future-proof.

  >> Martin van Rijn: The Dutch model combines social guarantees with market incentives. I’m convinced that with an eye on quality and cost control, this will be an excellent model.