Changes in the health insurance system in the Netherlands

European Journal of Health Law

Volumn 3, Issue 4, 1996, Pages 359-371

  Hamilton Van Hest, G C J M ^a  

^a MAASTRICHT UNIVERSITY   (Netherlands)

Author keywords

[No Author keywords available]

Indexed keywords

GOVERNMENT; HEALTH CARE POLICY; HEALTH ECONOMICS; HEALTH INSURANCE; MANAGEMENT; NETHERLANDS; REVIEW;

EID: 0030481558     PISSN: 09290273     EISSN: None     Source Type: Journal    
DOI: 10.1163/15718099620521824     Document Type: Review

References (25)

1. The author wishes to thank Professor H.D.C. Roscam Abbing for her comment on earlier versions of this article.
2. In this article "ziekenfondsen" are indicated as "social health insurance funds". Originally social health insurance funds carried out private insurance schemes. Later (since 1941) their functioning has been conditioned by law.
3. The scope of the "obligatory insurance" is as follows: the insurance is created by the law, those who fulfil the conditions set by law (largely based on income) are insured automatically by the law, entitlements are set by law and can be claimed in court. The only action to be taken by those who fulfil the requirements to be insured, is the administrative enrolment with a social health insurance fund.
4. They concern aspects of the contents of the contract (the nature and the extent of the relationship, quality of care to provide, administrative conditions, control of the performance of the contract, the beginning and the end of the contract, etc).
5. They include roughly people with an income that would be covered by the "Social Health Insurance Law" if they had been employees (like elderly people, students). Before 1986 these people could get a social health insurance on a free and private basis. The intention of the introduction of the Act on accessibility to health insurance is to create an alternative for this social health insurance standard which was abolished in 1986.
6. The Act on accessibility to health insurance was created as an alternative for the voluntary social health insurance.
7. Okma G.H., "This separate scheme may be described as a sickness fund within private insurance; or, ideologically speaking, as a form of nationalization of the business risk of private health insurance" in Financial dilemmas of health care policies in the Netherlands, International Health Economics Association Conference, Vancouver, May 1996.
8. For elderly people, children and students the premiums are lower.
9. Okma, G.H. 1994. 'De wet op de toegang tot ziektekostenverzekeringen opnieuw voor het voetlicht.' Sociaal Maandblad Arbeid.
10. The scope of the "obligatory insurance is as follows, the insurance is created by law, those who fulfil the conditions set by law (largely based on residents) are insured automatically by the law. Entitlements are set by law and can be claimed in court The only action to be taken by those who fulfil the requirements to be insured, is the administrative enrolment with the institution where they have their health-insurance.
11. In this function they will be indicated as social (public) health insurers.
12. In a step-by-step approach.
13. The so-called "Dekker Committee" (after the chairman) in "Willingness to change" (1987).
14. It was expected that the insured, who would choose their own insurance company, would choose the one with the lowest flat rate premium.
15. Until then the benefits were described provisional oriented, for example admission to (a recognized) hospital, or to (a recognized) nursing home. In a functional approach benefits are described in terms of cure and care as such. The benefits are no longer set out in detail by indicating persons or provisions who/which are supposed to deliver the entitlements. The functional approach would enable to deliver "measured care" to the individual need.
16. Worth mentioning in this framework is the possibillity for insured people to get a personal budget to organize their necessary home care themselves.
17. Because of the obligation to conclude contracts the social (public) health insurance system implied income guarantee for providers of health care. The new system brought changes in this income guarantee.
18. For newly graduated medical professionals it has become more uncertain though, whether they will succeed in getting contracts from social health insurance funds.
19. De rechtspositie van de verzekerde in net Nederlandse ziektekostenverzekeringssysteem, een analyse op hoofdlijnen, Prof. Dr. H.D.C. Roscam Abbing, G.C.J.M. Hamilton-van Hest, L.F. Markenstein, Utrecht 1995, ISBN 90-75657-01-3, p. 50.
20. R.N. van Donk, Zorgeloos contracteren, Overzicht van jurisprudentie sinds de inwerkingtreding van de Wet beperking contracteerplicht, Rechtspraak Zorgverzekering RZA, RZA-Kroniek, 1995, nr. 5.
21. Okma, G.H., Zorgeloos contracteren, Overzicht van jurisprudentie sinds de inwerkingtreding van de Wet beperking contracteerplicht, op .cit. p 6.
22. In the period 1992-1996 one could only choose another (public) health insurance fund every two years.
23. In the past the insured could be certain of the fact that all providers of care in the region of their domicile had a contract with their social health insurance fund.
24. The nominal premium caused no significant problems, probably because the nominal premium was - as start - set by the government in 1992 with a proportional lowering of the procentuel premium simultaneously and the absence of serious competition on the nominal premium. In the years 1992-1996 the nominal premium stayed at an acceptable level for the insured.
25. The government is competent according to the law to bind the flat rate premium to a ceiling.