going private? statutory health insurance, sickness funds and the development of private health...
TRANSCRIPT
Going private?
Statutory health insurance, sickness funds and the development of private health insurance in the Netherlands 1910-1986
R.A.A. Vonk
Centre for the history of health insurance, dept. Medical Humanities
Centre for the history of health insurance, dept. Medical Humanities
Centre for the history of health insurance, dept. Medical Humanities
- If and in what way sickness funds have influenced the private health insurance market during the period 1910 - 1986
Centre for the history of health insurance, dept. Medical Humanities
1900
- Poor Law (no income)
- Sickness fund insurance (low income)
- Out of pocket payment (middle/high income)
1910 – 1940
- ± 1910: private health insurers (comp. plans)
- 1912: binding resolution NMG
- 1910-1930: high failure rate and “malpractices”
- 1930: hospital plans
- Sickness funds as moral example
Centre for the history of health insurance, dept. Medical Humanities
Centre for the history of health insurance, dept. Medical Humanities
1941 – 1946
1941: Introduction of social health insurance
- compulsory (wage earners)
- voluntary (non wage earners)
- SHI schemes and PHI separated by an income limit
Centre for the history of health insurance, dept. Medical Humanities
Sickness Fund Decree: repercussions
- PHI-companies lose major part portfolio
- Sickness funds start to offer suppl. insurance
- Sickness fund prohibited to provide PHI
Centre for the history of health insurance, dept. Medical Humanities
1947-1969
- Expansion social health insurance (income limit)
- 1947: Bovenbouwers (PHI related to sickness funds)
- Sickness funds and private insurers against national
health insurance
- 1957: ANPZ-policy and VVBR risk-pool
Centre for the history of health insurance, dept. Medical Humanities
1947-1969
- 1962: KLOZ (umbrella org. private health insurers)
- Plans to reform health care sector (BVV/AWZ)
- Bovenbouwers and insurers join forces
- 1967: NOZ risk-pool
Centre for the history of health insurance, dept. Medical Humanities
Centre for the history of health insurance, dept. Medical Humanities
1971-1980
- No immediate threat National Health Insurance
- Escalating risk segmentation / premium differentiation
- Skimming voluntary social health insurance
- Bovenbouwers apply entrepreneurial principles
Centre for the history of health insurance, dept. Medical Humanities
1971-1985
- 1971: Zeven pijlers-plan
- 1974: Restructuring effort
- 1986: WTZ- Dissolving voluntary social health insurance
- Socializing private health insurance
- Standard policy
- Compulsory acceptance
- Fixed premium
Centre for the history of health insurance, dept. Medical Humanities
Centre for the history of health insurance, dept. Medical Humanities
Conclusions
- Moral example
- “socialization” through competition (1960’s)
- SHI-principles enter PHI
- Failing self regulation (1970’s)
- PHI-principles enter SHI (bovenbouwers)
- Government intervention (1980’s)
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