Health insurance in the Netherlands
The health insurance in the Netherlands is a general liability insurance ; it covers a degree of healing treatment defined as necessary .
On January 1, 2006, a new health insurance system was introduced with the health reform in the Netherlands . The classic difference between statutory and private health insurance no longer applies. As of this date, all residents of the Netherlands are required to take out statutory health insurance with a health insurance provider.
Basics
Historically, the Dutch health insurance system for general medical care was very fragmented until 2005. A significant part of the population, around 60 percent, had statutory health insurance. Others had taken out private insurance, although certain risk groups had the option of taking out a standard statutory policy. There were also special public health insurance regulations for certain groups of civil servants. Over the years, two systems, including special civil servant regulations, even three systems have emerged for insurance against the costs of curative medical treatment, which differ significantly from one another in terms of their basis, their function and their financial consequences for the insured.
In the years before the health insurance reform, however, the fees for medical treatment for those with statutory health insurance were increased slightly each year and those for treatment for privately insured persons were reduced, so that the reimbursements for both patient groups had already been equalized by the end of the 1990s.
With the new Health Insurance Act, Health Minister Hans Hoogervorst pursued the goal of replacing the existing fragmented system with uniform statutory insurance for all residents of the country. The Health Insurance Act puts an end to the situation where people with comparable income pay significantly different contributions and that insurance depends on the employment situation. The law not only provides for the creation of a level playing field for insurers and policyholders, but also for the role of citizens, service providers and insurers to be empowered to act as efficiently as possible in the health system . Citizens are given more financial responsibility as well as more influence and real freedom in choosing health insurance. Insurers will compete more intensely with each other in order to get the best value for money from service providers for their insured parties. The service providers for their part have to work in a more performance-oriented manner, but are also given more opportunities to offer precisely the services that citizens need and want.
The government wanted to create an insurance system that on the one hand strengthens individual responsibility and market function and on the other hand offers a solid foundation for social framework conditions such as solidarity between different income and risk groups. Against the background of the reforms that have been carried out in the health system over the past fifteen years - for example the introduction of competition in health insurance and solidarity surcharges in private health insurance - the new health insurance system is more a logical step in the same direction than a rupture with the past.
Cornerstones of the Health Insurance Act
Compulsory insurance
All residents of the Netherlands must have health insurance. To do this, they sign a contract with an insurance company . What the service package looks like is regulated by law.
Standard package with necessary services
The standard service package under the new Health Insurance Act includes necessary, curative services that have been checked for their effectiveness, cost efficiency and collective financial feasibility.
Implementation by nationwide operating insurers; Admission and performance obligation
The insurance is carried out by private insurance companies that meet the requirements specified in the Health Insurance Act. As a non-life insurer, you are also bound by the laws governing the non-life insurance industry. Profit-making intentions are allowed; the profit can be distributed to the shareholders if necessary. The currently active private health insurers can continue to exist as such, and the previous health insurers can transform themselves into private providers. The market is also open to new providers.
The efficiency of the new system is ensured by the fact that the insurance companies are constantly competing with one another. The insured persons can change the provider annually and the providers are not allowed to refuse anyone who lives in their area of activity as an insured person.
In principle, the insurer can decide for himself in which form the standard package is offered. Benefits in kind as well as reimbursement or a combination of both are possible. The insured can also freely choose one of these forms.
Flat rate contribution
Almost half of the total contribution burden is borne by the insured in the form of a lump sum. This promotes cost awareness. The insurers can set the flat rate for each policy they offer. However, one important rule applies here: only one single premium level may apply to each type of policy. The age, state of health or social situation of the insured person must not play a role. Everyone who has the same policy also pays the same premiums. Differences between the individual insurers are of course possible. This promotes competition between insurance companies and increases the cost awareness of the insured. Reduced premiums may be offered for group insurance. The flat-rate contributions for 2006 were likely to be limited to an average of 1,100 euros per year. In reality, the offers made by insurance companies averaged 1050 euros.
Insured persons up to the age of 18 do not pay a lump sum. To finance the system for minors, a state contribution is paid into the health insurance fund.
Income-related contribution
In addition to the flat-rate contribution, the Health Insurance Act provides for an income-related insurance contribution. It is calculated as a percentage of income (for employees in 2008: 7.2 percent up to 30,000 euros). Employers are obliged to reimburse their employees for the income-related contribution they have paid. The tax authorities are responsible for collecting these contributions and paying them into a health insurance fund (or: ' health fund '). The income-related contributions will - calculated over the entire population - cover around 50 percent of the total contribution burden.
State contributions
The contributions for children and young people under the age of 18 are financed by state payments into the health insurance fund.
Risk balancing
The income of the insurance companies consists of the flat-rate contributions of their policyholders and the risk equalization payments that they receive from the health insurance fund (or: ' health fund') , depending on the risk profile of their policyholders . Without a well-functioning risk compensation system, an obligation to contract would not be feasible, because the insurers have no influence on who they accept and who not. With a disproportionately high number of “bad risks”, considerable financial problems could arise. In order to prevent this and to create a "level playing field" for insurers, a risk compensation system with clear criteria that are identical for all insurers is essential.
Deductible
For all insured persons aged 18 and over, an obligatory deductible of 150 euros per year has been in force since 2008. In addition, the insurers can also offer a more extensive voluntary deductible: it can vary from 100 to 500 euros per year. The mandatory deductible has replaced the premium repayment introduced in 2006. Under this system, insured persons aged 18 and over who had no or only a few medical services in a calendar year were entitled to a premium refund. This was the case if the value of the insured benefits that were used in the relevant calendar year did not exceed a maximum amount set in advance. The insured person was then reimbursed the difference between the value of the services used and this maximum amount (2006: 255 euros).
Health grant
With the introduction of the Health Insurance Act, a uniform contribution system will be created for all insured persons. As already mentioned, the contributions consist of an income-related part, which is collected by the tax authorities, and a flat-rate part, which is payable directly to the insurer. In order to ensure that no one is financially overwhelmed by health insurance, a health grant was introduced. The amount of this subsidy depends on the income of the insured. This compensates for that part of the flat-rate contributions that exceeds a limit set as reasonable. So that citizens can actually compare the offers of different insurers with one another, the calculation of the amount of the health subsidy is not based on the insurance premiums actually paid, but on the average amount of the flat-rate premiums on the market. A new office affiliated with the tax authorities is responsible for paying out the subsidies. Citizens eligible for a grant must submit an application annually in which they estimate their own income and that of their partner for the coming year. On this basis, they then receive a grant from the state every month.
Long-term supply
In 1968 the so-called General Law on Special Medical Costs (the Algemene Wet Bijzondere Ziektekosten , AWBZ) came into force. It envisaged compulsory insurance for all residents of the Netherlands against serious medical risks that were considered uninsurable for the individual. One should think of stays in a facility for the disabled or in a nursing home or of very long hospital stays. This insurance should continue to exist alongside the new health insurance until further notice after January 1, 2006.
On January 1, 2015, the AWBZ was replaced by the Law on Long-Term Care (the Wet Langdurige Zorg , WLZ).
literature
- Geert Jan Hamilton: The Dutch Healthcare Reform 2006 - A Model for Germany? Law and Politics in Health Care, organ of the Society for Law and Politics in Health Care , Volume 12. Issue 1/2006, pp. 3–13.
- Eberhard Wille, Geert Jan Hamilton, Johann-Matthias Graf von der Schulenburg, Gregor Thüsing: Organization of statutory health insurances under private law, reform prospects for Germany, experiences from the Netherlands. Nomos Verlagsgesellschaft, Baden-Baden 2012. ISBN 978-3-8329-7635-4 .
- Geert Jan Hamilton: The health insurance system in the Netherlands: from duality to unity. Health economics and quality management magazine, June 18, 2013. Georg Thieme Verlag KG. Pp. 123-135.
Web links
- The new health system in the Netherlands . (PDF file, 1.35 MB, Dutch)
- The Changing Role of the State in the Dutch Healthcare System. (PDF file; 0.8 MB, English)
Individual evidence
- ↑ The example of the Netherlands shows: Citizens' insurance could be expensive for taxpayers. Focus Online, December 21, 2017, accessed July 29, 2019 .
- ↑ Do you have to apply for an assessment of your Wlz insurance situation? (No longer available online.) Sociale Verzekeringsbank, archived from the original on July 1, 2016 ; Retrieved June 2, 2016 (Dutch). Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ Wet long-lasting zorg (Wlz). (No longer available online.) Rijksoverheid, archived from the original on June 17, 2016 ; Retrieved June 2, 2016 (Dutch). Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
