1 20 apr 2023

ZN‘Providing a unified voice for the

Dutch health insurers’

Walter Annard

Director Public Affairs

2 20 apr 2023

Topics

■ The health insurance system■ The health insurers market■ The trade association■ Main issues

3 20 apr 2023

Organisation and finance of health care system

Insurer and Insurance premium

Government and taxes

Social insuranceMix private / social

insurance

AustriaFranceBelgium

Luxembourg

NetherlandsGermany

Categorical Universal

DanmarkIreland

PortugalGreeceSweden

ItalyUK

CanadaNorwayFinland

Private insurance

SwitzerlandUSA

I International comparison

4 20 apr 2023

The system

■ Three main characteristics:

• Dutch health care is private sector

• Accessibility guaranteed by layered system of insurances

• Managed competition

5 20 apr 2023

Current system: three compartments

6 20 apr 2023

Long term care insurance■ Compulsory protection (Exceptional Medical

Expenses Act) for all citizens

■ Cover:● Benefits in kind, for some health care services

sums of money● Care for elderly, physically and/or mentally

disabled people with chronical diseases, psychiatric patients

■ Premium: 13,45% over income per 1/1/2005

7 20 apr 2023

Social health insurance (1)

■ Compulsory insured● Total number: 10,1 mln. People, 2/3

population

■ Wage limit (wage limit emplyees 2005: 33.000 euro)

■ Benefits in kind■ Coverage: general practitioner, hospital

care, pharmaceutical care, obstetrics

8 20 apr 2023

Social health insurance (2)

■ Two-tier premium• income related of 8,2 % (employer 6,5%

- employee: 1,7 %• Flat rate premium (individual

insurers)approximately 360 euro per person per year based on commmunity rating

■ Carried out by non-profit insurers (mutual funds)

9 20 apr 2023

Private health insurance■ Voluntary protection• Fee for service• Flat rate premiums based on experience rating• Cover parallel with social insurance ■ Nominal premium, on average 147 euro per

month ■ 1/3 of population■ Carried out by profit en non-profit insurers■ Regulated by European Union law (directive)

10 20 apr 2023

Supplementary insurance

■ Voluntary insurance for everyone with a social and private insurance

■ Coverage against costs of dental care for adults, physiotherapeutical care, cosmetic surgery, homeopathic medicines, etc.

■ Offered both by social and private insurers

11 20 apr 2023

Basic Health Insurance

12 20 apr 2023

Characteristics I

■ One health insurance for every citizen covering cure

■ Private insurance (EU-legislation, for profit).

■ Private….but with public guarantees (‘crown jewels’):

* Mandatory enrollment/no risk selection* Pooling

13 20 apr 2023

Characteristics II■ Variaty in package (FFS/benefits in kind,

possibility PPO)■ Mixed premium (2200 euro a year)

• Employer contribution• Flat rate premium

■ No claim (250 euro a year)■ Competition on basis premium, package,

service, supplementary insurance■ For profit

14 20 apr 2023

Flow of money Basic Health Insurance

Employer

Government

Insured Insurer

Pooling fund

Individual compensation

Employer contribution 50%

Tax contribution 5%

Flat-rate premium 45%

Dis

tribu

tion

15 20 apr 2023

II The Market

2/3 populationmandatory (EMEA, SHI)

and supplementary insurance

1/3 populationmandatory (EMEA)

and private (substitutive) insurance

16 20 apr 2023

The market

■ Number of 59 health insurers in 2005:

• 22 public insurers

• 37 private insurers

• Proces of mergers and strategic cooperation between and within groups of public and private insurers

17 20 apr 2023

PositioningTransformation from executive body (health

insurance funds) and indemnity insurer (private insurers) to ‘health service company’

Three main tasks:■ To insure risks■ To purchase health care providers (PPO,

HMO)■ Offering services like prevention activities,

waiting list mediation

18 20 apr 2023

III The trade association ZN

■ History■ Members■ Mission and main tasks■ Lobby

19 20 apr 2023

History

■ ‘Polder model’, Dutch expression voor civic society

■ Zorgverzekeraars Nederland was founded in 1995

20 20 apr 2023

Our members

■ 37 members■ Regional versus national operating

health insurers ■ Solo versus multi branche■ Profit versus non profit

21 20 apr 2023

Mission

■ “Realising favourable conditions in which the Dutch health insurers can work as entrepreneurs in ‘health and security’. We see it as a common interest to provide affordable access for each citizen to a high standard of care, sharing values as: security, empathy and solidarity.

22 20 apr 2023

Main tasks

■ Advocacy of industry interests in The Hague and Brussels

■ Spokesperson to media■ Representation in (international) government

boards, committees and/or advisory bodies■ Research and policy development■ Support and services■ Code of conduct

23 20 apr 2023

Lobby

■ Monitoring developments in The Hague and Brussels■ Analysing issues■ Networking with government, politicians, journalists.

Main rule: good relationship with civil servants is essential

■ Forming alliances with associations for health care providers, consumers, employers, etc

■ Active use of publicity and management by speech ■ Use of internet (www.zn.nl)

24 20 apr 2023

Main issue

■ Introduction basic health insurance