The health care sector is of great financial and social importance. Technological developments and population ageing will push up costs further in the years ahead. The aim of the system change is to better control these costs and promote efficiency through market forces and competition in the health insurance and care provision markets. Health insurers play a key role in the new system.
The health care system in brief
All Dutch nationals who are insured by operation of law under the Exceptional Medical Expenses Act (Algemene wet bijzondere ziektekosten –AWBZ) are obliged to insure themselves against other medical expenses. The Zvw provides for a standard insurance which is the same for everyone. If they wish, people can take out supplementary insurance for medical expenses outside the standard package. The Zvw is a social security scheme administered by private insurers that guarantees universal medical care.
Since the introduction of the Zvw, private individuals, care providers and insurers have had greater freedom of choice and more individual responsibilities. The aim is to make the system more efficient and demand-driven by having insurers compete among each other and negotiate with care providers on price and quality of the care they offer. Care providers in turn compete among themselves for contracts with insurers. Insurers must pay greater attention to health care costs and customer orientation. Private individuals choose their health insurer on the basis of price, quality and service level.
Health insurers are obliged to accept all persons who apply for basic insurance and are not allowed to charge different premiums according to personal characteristics. A netting scheme ensures that health insurers are compensated for any over-representation of bad risks (such as chronically sick and elderly people) in their portfolio.
DNB makes every effort as prudential supervisor to gain a clear perspective on the operational set-up and financial position of individual institutions. Attention areas include the consequences of the netting scheme and the Combined Diagnosis and Treatment System known as DBC. Effective from 1 January 2016, all private health insurers come under the European risk-based supervision framework, Solvency II. This framework takes the Dutch netting scheme for basic health care into account.