Web-economic-crisis-health-systems-and-health-web
Web-economic-crisis-health-systems-and-health-web Web-economic-crisis-health-systems-and-health-web
Chapter 8 | The impact of the crisis on the health system and health in the Netherlands 261 Table 8.4 Measures shifting costs to the insured in the Netherlands, 2008–2013 Year Measure 2008 Introduction of a compulsory deductible of e150 per year, replacing "no-claim" regulation 2009 Compulsory deductible increased to e155 2010 Compulsory deductible increased to e165 2011 Compulsory deductible increased to e170 Gradual decrease of care allowance to take place between 2011 and 2040 by increasing the percentage of income that may be spent on the community-rated premium 2012 Compulsory deductible increased to e220 The gradual decrease of care allowance (see above) adjusted in a way that lower incomes are protected more than higher incomes Introduction of a co-payment for secondary mental health care of e100–200 per treatment Increase of the co-payment for primary mental care from e10 to e20 per session Increase of the co-payment for stay in mental care hospital of e145 per month 2013 Compulsory deductible increased to e350 Maximum income for the eligibility for care allowance decreased from e35,059 to e30,939 for singles and from e51,691 to e42,438 for two-person households Private assets above e100,000 taken into account when considering eligibility for care allowance 8% of taxable assets are included in the calculation of cost-sharing for long-term-care (previously, assets were not included in the calculation of cost-sharing) Shifting costs to insurers Since 2012, health insurers no longer receive retrospective compensation for macroeconomic developments (macronacalculatie) and for outlier risk sharing (hogekostencompensatie) – for large deviations from the budget set by the government. The latter compensated 90% of the costs of an insured individual above a certain threshold. The abolition of this compensation was primarily meant to shift the risk for these deviations from the state to the insurers, but also to promote competition among insurers: if health insurers bear more risk, they will have the incentive to negotiate better contracts with health care providers and this would allow them to offer lower premiums and sell more health insurance plans. The cost of health plans indeed decreased in 2014, but it is not clear whether this was a result of negotiations or other causes, such as higher (than expected) profits in the previous year or selling cheaper health plans with higher voluntary deductibles.
262 Economic crisis, health systems and health in Europe: country experience Reduction of overspending Overspending has been a long-standing problem in both primary and specialized care. Since 2008, if health care providers exceeded the amounts agreed in the contracts, they have had to pay back the amount overspent in the next year. This was done in the form of tariff measures (Table 8.5). Such tariff measures have been applied to care provided by GPs, medical specialists and hospital facilities and to some extent also to pharmaceutical care (clawbacks). Tariff measures applied to medical specialist care appeared not to be very effective, since the overspending in the area of specialist care remained relatively high in 2009–2011 (at 13–52%; see Table 8.2), whereas overspending on GP care and on the use of hospital facilities remained below 10% of their respective budgets in the same period. More measures to curb overspending have been implemented since the emergence of the crisis. Changes to somatic care In 2009, the normative times assigned to treatments by medical specialists and the compensation for supporting specialists (e.g. radiologists, medical specialists who are not the main responsible physicians and treating physicians) were reconsidered (i.e. recalculated with new assumptions) 7 and the Health Care Authority formulated measures aimed at recovering overspending. For example, the budget for tariffs for medical specialists was cut by €375 million in 2009 (Table 8.5). The announcement of further cuts in 2010 (€512 million) led to many protests by medical specialists, resulting in an agreement in December 2010, signed between the Association of Medical Specialists (Orde van Medisch Specialisten), the National Hospital Association (Vereniging van Ziekenhuizen) and the Ministry of Health. 8 The budget for specialized care was to be capped at €2 billion per year in 2012, with the growth in budget limited to 2.5% per year until the tariffs of medical specialists become part of the free negotiations between providers of secondary care and insurers, which is assumed will happen in 2015 (Association of Medical Specialists, National Hospital Association & Ministry of Health, 2010). At present (2014), 70% of hospital care is subject to price negotiations between insurers and hospitals, while the remaining 30% of tariffs is set by the Health Care Authority. However, 7 Treatment times for medical specialists and supporting specialists are difficult to estimate and remain approximations of actual treatment times. 8 Agreements between the Ministry of Health and health care providers or health insurers are concluded by their respective umbrella associations on their behalf. These associations have no means of controlling production of health care services or to sanction any unwanted behaviour of their members. The system of agreements works because there is always the latent threat that the Ministry of Health can impose measures, such as tariff cuts, if the agreed terms are not met (e.g. if there is overspending). Since the role of the government in the Dutch health care system is to watch from a distance rather than to be directly involved, the preference is to use agreements negotiated between the parties instead of imposing measures in a one-way fashion by the Ministry of Health. It is assumed that the health purchasing market (insurers purchase care from health care providers) will provide sufficient incentives for both insurers and providers to produce health care of good quality at acceptable prices. It is important to mention that the use of agreements between parties is part of Dutch political culture and such agreements also exist in other sectors, for example in the education sector.
- Page 243 and 244: 210 Economic crisis, health systems
- Page 245 and 246: 212 Economic crisis, health systems
- Page 247 and 248: 214 Economic crisis, health systems
- Page 250 and 251: Chapter 7 The impact of the crisis
- Page 252 and 253: Chapter 7 | The impact of the crisi
- Page 254 and 255: Chapter 7 | The impact of the crisi
- Page 256 and 257: Chapter 7 | The impact of the crisi
- Page 258 and 259: Chapter 7 | The impact of the crisi
- Page 260 and 261: Chapter 7 | The impact of the crisi
- Page 262 and 263: Chapter 7 | The impact of the crisi
- Page 264 and 265: Chapter 7 | The impact of the crisi
- Page 266 and 267: Chapter 7 | The impact of the crisi
- Page 268 and 269: Chapter 7 | The impact of the crisi
- Page 270 and 271: Chapter 7 | The impact of the crisi
- Page 272 and 273: Chapter 7 | The impact of the crisi
- Page 274 and 275: Chapter 7 | The impact of the crisi
- Page 276 and 277: Chapter 7 | The impact of the crisi
- Page 278: Chapter 7 | The impact of the crisi
- Page 281 and 282: 248 Economic crisis, health systems
- Page 283 and 284: 250 Economic crisis, health systems
- Page 285 and 286: 252 Economic crisis, health systems
- Page 287 and 288: 254 Economic crisis, health systems
- Page 289 and 290: 256 Economic crisis, health systems
- Page 291 and 292: 258 Economic crisis, health systems
- Page 293: 260 Economic crisis, health systems
- Page 297 and 298: 264 Economic crisis, health systems
- Page 299 and 300: 266 Economic crisis, health systems
- Page 301 and 302: 268 Economic crisis, health systems
- Page 303 and 304: 270 Economic crisis, health systems
- Page 305 and 306: 272 Economic crisis, health systems
- Page 307 and 308: 274 Economic crisis, health systems
- Page 309 and 310: 276 Economic crisis, health systems
- Page 311 and 312: 278 Economic crisis, health systems
- Page 313 and 314: 280 Economic crisis, health systems
- Page 316 and 317: Chapter 9 The impact of the crisis
- Page 318 and 319: Chapter 9 | The impact of the crisi
- Page 320 and 321: Chapter 9 | The impact of the crisi
- Page 322 and 323: Chapter 9 | The impact of the crisi
- Page 324 and 325: Chapter 9 | The impact of the crisi
- Page 326 and 327: Chapter 9 | The impact of the crisi
- Page 328 and 329: Chapter 9 | The impact of the crisi
- Page 330 and 331: Chapter 9 | The impact of the crisi
- Page 332 and 333: Chapter 9 | The impact of the crisi
- Page 334 and 335: Chapter 9 | The impact of the crisi
- Page 336 and 337: Chapter 9 | The impact of the crisi
- Page 338 and 339: Chapter 9 | The impact of the crisi
- Page 340 and 341: Chapter 9 | The impact of the crisi
- Page 342 and 343: Chapter 9 | The impact of the crisi
Chapter 8 | The impact of the <strong>crisis</strong> on the <strong>health</strong> system <strong>and</strong> <strong>health</strong> in the Netherl<strong>and</strong>s<br />
261<br />
Table 8.4 Measures shifting costs to the insured in the Netherl<strong>and</strong>s, 2008–2013<br />
Year<br />
Measure<br />
2008 Introduction of a compulsory deductible of e150 per year, replacing<br />
"no-claim" regulation<br />
2009 Compulsory deductible increased to e155<br />
2010 Compulsory deductible increased to e165<br />
2011 Compulsory deductible increased to e170<br />
Gradual decrease of care allowance to take place between 2011 <strong>and</strong><br />
2040 by increasing the percentage of income that may be spent on the<br />
community-rated premium<br />
2012 Compulsory deductible increased to e220<br />
The gradual decrease of care allowance (see above) adjusted in a way<br />
that lower incomes are protected more than higher incomes<br />
Introduction of a co-payment for secondary mental <strong>health</strong> care of<br />
e100–200 per treatment<br />
Increase of the co-payment for primary mental care from e10 to e20 per session<br />
Increase of the co-payment for stay in mental care hospital of e145 per month<br />
2013 Compulsory deductible increased to e350<br />
Maximum income for the eligibility for care allowance decreased from<br />
e35,059 to e30,939 for singles <strong>and</strong> from e51,691 to e42,438 for<br />
two-person households<br />
Private assets above e100,000 taken into account when considering<br />
eligibility for care allowance<br />
8% of taxable assets are included in the calculation of cost-sharing for<br />
long-term-care (previously, assets were not included in the calculation<br />
of cost-sharing)<br />
Shifting costs to insurers<br />
Since 2012, <strong>health</strong> insurers no longer receive retrospective compensation for<br />
macro<strong>economic</strong> developments (macronacalculatie) <strong>and</strong> for outlier risk sharing<br />
(hogekostencompensatie) – for large deviations from the budget set by the<br />
government. The latter compensated 90% of the costs of an insured individual<br />
above a certain threshold. The abolition of this compensation was primarily<br />
meant to shift the risk for these deviations from the state to the insurers, but<br />
also to promote competition among insurers: if <strong>health</strong> insurers bear more<br />
risk, they will have the incentive to negotiate better contracts with <strong>health</strong> care<br />
providers <strong>and</strong> this would allow them to offer lower premiums <strong>and</strong> sell more<br />
<strong>health</strong> insurance plans. The cost of <strong>health</strong> plans indeed decreased in 2014, but<br />
it is not clear whether this was a result of negotiations or other causes, such as<br />
higher (than expected) profits in the previous year or selling cheaper <strong>health</strong><br />
plans with higher voluntary deductibles.
Change language