| What are the three waves of healthcare reforms observed in many OECD countries? | 1. Universal coverage and equal access.
2. Controls, rationing, and expenditure caps.
3. Incentives and competition. |
| Explain the sickness fund decision of 1941 | - 1st gov regulation in hc insurance
- MANDATORY sickness fund membership for employees up to a certain income level
-Income-related premium to Central Fund, 100% cost-based payments to sickness funds. |
| Explain reasons why the NHI proposals failed? | 1. Resistance from doctors
2. Resistance from private health insurer
3.Too large income redistribution
4. too large public health expenses
5. different political opinions |
| Explain the two tier system of 1941-2005 | - There was Mandatory public health insurance (sickness fund- SFI) for lower-income people (⅔ pop) with an income-related premium
-Voluntary private health insurance for high-income people (⅓ population)- increasing problems with risk-rating and risk selection. |
| What were the main objectives of the "Dekker proposals " in the Netherlands in 1987 | 1. regulated competition among insurers and providers of care
2. Mandatory Health insurance for everyone( abolish the difference between sickness fund and private health insurance. |
| What are the key elements of the reform(Dekker proposals) | 1. Role of purchaser of care: from govt to competing private insurers
2.Gov-deregulated price and capacity controls.
3. Not free market, regulated competition
4. (Gov regulation protects public goals- affordability, access, and quality of care) |
| what are the tools to improving the efficiency of the Dekker proposals | 1. Govt- legislation and other regulations with respect to prices, budget, hospital planning, manpower planning, investment, certificates of need, etc
2. Insurers- private contract with providers, selective contracting, negotiations abt price and quality, etc |
| explain the convergence of public and private health insurance (Dekker) | - The difference between public and voluntary private insurance diminished.
- Medical prices equal for publicly and privately insured
-there were mergers between public and private insurance
- public HI market became more competitive |
| Explain the Health Insurance act(2006) | - There was a mandate for everyone in the Netherlands to buy individual private Health Insurance
-Standard benefit package, broad coverage, described in terms of functions of care ( flexible)
-Mandatory deductible ; eg 385 in 2018 per person
-Open enrolment & community rating.
-Selective contracting and vertical integration allowed |
| Give some unique features of the Dutch System’s | 1. Annual consumer choice of insurer and insurance contract
- In-kind (sickness funds) or reimbursement ( private), or a combo of both
-Preferred provider arrangement
-Voluntary higher deductible, E,G 500 euro extra
-Voluntary supplementary insurance- services not included in the package |
| What is the main difference between 'in-kind' and 'reimbursement' health insurance contracts in the Netherlands? | In an 'in-kind' contract, the insurer arranges care with contracted providers, often at no cost beyond deductibles. In a 'reimbursement' contract, the insured can choose providers and claim reimbursement, potentially facing higher out-of-pocket costs if the price exceeds the Dutch market rate. |
| Explain the term "duty of care" for in kind contracts | -Insurers have a “ duty of care”
-Must guarantee the delivery of care
-Care must be deliverable in a timely fashion ( national norms for max waiting times)
-Insurers can go to court if fail to provide contract obligations |
| Mention the entitlements in "in kind" contracts and what it entails | 1.Contracted providers: insurer receives care for free- deductible
2. Non-contracted: The insured gets a reimbursement(set by the insurer) ((except urgent care is fully reimbursed) |
| explain the term duty of care in a reimbursement contract | -Must have a call centre and inform the insured about the waiting times of the providers
- They only have to make an effort
-If care cannot be provided within acceptable max waiting times, the insured cannot successfully go to court |
| What is the purpose of the Risk Equalization Fund (REF) in the Dutch healthcare system? | The REF aims to balance financial risk among insurers by compensating them for high-risk enrollees using risk adjusters like age, region, and prior health costs. |
| Cross border healthcare in the EU - Explain the Coordination Regulation | 1. Incase of urgent care - Use EHI CARD
2. non urgent care- ask prior approval from your health insurance |
| Explain the S2- form | -Only covers for care that is covered by the homeland mandatory insurance
-Approval cannot be denied for long waiting time in the patients home country |
| What is required for non-urgent cross-border care under the Coordination Regulation (EC) NO 883/2004? | Patients must obtain prior approval from their insurer through the S2-form, with entitlements based on the statutory health insurance of the country providing the care. |
| What are the adverse effects of risk selection in the Dutch healthcare system? | -Discourage responsiveness to high-risk consumers.
-Prioritize selection over efficiency, reducing care quality.
-Create market segmentation, threatening healthcare solidarity. |
| How does the Dutch healthcare system handle reimbursements for care received in non-EU countries? | Dutch insurance provides worldwide coverage, but reimbursements are capped at the cost equivalent in the Netherlands, and additional travel insurance is often recommended for non-EU healthcare. |
| Define Bismarck | people pay a fee to a fund that in turn pays for health care activities, that can be provided by State-owned institutions, other Government body-owned institutions, or a private institution. |
