Analysis of the Abolishment of Ex-Post Compensation in the Dutch Health Care System

Topics: Health care, Health insurance, Health economics Pages: 12 (3762 words) Published: June 13, 2013
Sustainable Drug Development GEO3-2266

Analysis of the abolishment of ex-post compensation in the Dutch health care system

Marc van Moorsel 3710688
Carlijn Huijsmans 3697088
Supervised by Prof. Dr. H. Schellekens & Dr. H.C. Ebbers
Utrecht University
01-11-2012

Summary
The Dutch government has taken several measures to improve the efficiency of the health care system. Two important measurements include the law of medical drug prices, which offers the minister of public health the opportunity to determine maximum prices of prescription drugs two times each year, and the preference policy, which allows the health care insurance companies to oblige pharmacists to distribute their favorable generic drug to patients who are insured by them. Together, these measurements have cut down medical prices and thereby improved the efficiency of the Dutch health care insurance companies.

Furthermore, the risk equalization model has proved to influence the efficiency of insurance companies positively. This model follows from the Law of Health Insurance (Zorgverzekeringswet), which obligates all Dutch citizens above the age of 18 to have a health care insurance, and the acceptance obligation, with which the Dutch government obliged these companies to accept every patient for the nominal, basic health care insurance, without differentiation in nominal premiums. Since the ex-post compensation made sure that a part of insurance companies’ losses would always be compensated retroactively, the Dutch government stimulated health insurance companies to increase expediency with the purchase of health care, by the planned stepwise abolishment of this ex-post compensation. The government’s philosophy is that this increased expediency increases efficiency of the Dutch health care. Since the ex-post compensation is needed because the ex-ante compensation is insufficient, the ex-ante compensation should be improved first to successfully abolish the ex-post compensation.

This report investigates what the influence of the abolishment of the ex-post compensation is on the efficiency of health care provided by Dutch insurance companies, and how this abolishment could be applied successfully. This is done by the execution of an analysis of the risk equalization in the Dutch health care system. Literature from both the opponents as well as the proponents of the abolishment has been consulted and resulted in an advice for the Dutch government. This advice reads as follows: focus on the improvement of the ex-ante compensation by expanding DKG’s and adjusting the criterion for MHK. This will enable a successful abolishment of the ex-post compensation. It will also contribute to the development of a sustainable health care system.

Table of content

1. Introduction……………………………………………………………………………………………………………………………………4

2. Analysis of the risk equalization model ………………………………………………………………………….……..5

2.1. Effects of the abolishment of ex-post compensation on the health Insurance companies…………………………………………………………………………………………………………………………………….…….5

2.2 Successful abolishment of ex-post compensation………………………………………………………………7

2.3 Preliminary results…………………………………………………………………………………………………………………… 8

3. Conclusion………………………………………………………………………………………………………………………………………9

4. Discussion ………………………………………………………………………………………………………………………………………9

5. References……………………………………………………………………………………………………………………………………10

1. Introduction
According to data of the Dutch ‘Stichting Farmaceutische Kengetallen’ (SFK), prices of prescription drugs have been decreased by 1,2 percent in the month September 2012 and have been cut halves in the last 15 years (SFK, 2012).

The SFK gives several reasons as possible explanation for the declination of prescription drug prices. Among those reasons the law of medical drug prices (WGP) of 1996 and the preference policy of the health care insurance companies of 2008 are mentioned. The...

References: Broeren J., 15-10-2012, Recente ontwikkelingen in de gezondheidszorg: welke gevolgen heeft dat voor de farmaceutische indrustrie?, Gast college Universiteit Utrecht bij cursus Sustainable Drug Development
Don H., juni 2012, Evaluatie risicoverevening zorgverzekeringswet, Commissie Evaluatie Risicoverevening ZVW, Den Haag
Maes A., 17-04-2012, Afschaf van de postverevening met compensatie juist winstgevend voor….Zorgverzekeraar?, De vrije huisarts
Ministerie van Volksgezondheid, Welzijn en Sport, 2007, Beschrijving van het risicovereveningssysteem van de zorgverzekeringswet, p 112.
Nederlandse Zorgautoriteit, oktober 2007, Samenvattend rapport Uitvoering Zorgverzekeringswet 2006, pp. 13-44, Nederlandse Zorgautoriteit, 2009, Budgetschoning B-segement, geraadpleegd op 23-10-2012 via <http://www.nza.nl/zorgonderwerpen/dossiers/budgetschoning-b-segment/>
Schippers, 2012, kamerbrief ex ante risicovereveningsmodel 2013
Schut E., mei 2011, Risicoverevening: hoe zit het nu precies, De Eerstelijns, nr. 4, pp. 10-11
Stam P.J.A., 2007, Testing the effectiveness of risk equalization models in health insurance : a new method and its application: Het toetsen van de effectiviteit van risicovereveningsmodellen voor zorgverzekeringen : een nieuwe methode en haar toepassingen, PhD Thesis Erasmus Universiteit Rotterdam
Stichting Farmaceutische Kerngetallen, 4-10-2012, Nieuw risico door nieuwe maximumprijzen, Pharmaceutisch Weekblad, Jaargang 147, nr. 40
Ven van de W.P.M.M., Schut F.T., Hermans H.E.G.M., Jong de J.D., Maat van der M., Copen R., Groenewegen P.P., Friele R.D., september 2009, Evaluatie Zorgverzekeringswet en Wet op de zorgtoeslag, ZonMw Den Haag, deel 27
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