Title: Role of General Health Insurance Company VZP in the Czech health insurance market today and tomorrow
1Role of General Health Insurance Company (VZP) in
the Czech health insurance market today and
tomorrow
Pavel Horak, M.D., Ph.D., MBA, General Director
Prague September 24, 2007
2Health Insurance System CRtoday and tomorrow
- Covers all persons with permanent residence in
the Czech Republic and persons employees of an
employer whose seat is located in the Czech
Republic - European health care and health care insurance
market will become more and more interconnected - Basic principles will not change
- Compulsory participation
- Solidarity
- Free choice of the healthcare provider (at least
for certain products)
3VZP CR is the biggest health insurance company in
the Czech Republic
Some indicators of VZP CR 2007
4Unlike in the past, debt and deficits are not a
problem for VZP anymoreCurrently VZP is
financially stable
5Contractual Healthcare Facilities
- Significant changes are expected to occur
- ( hospitals, ownership, contracting policies)
- Outpatient healthcare facilities
33 750 - Inpatient healthcare facilities in total
267 - Spas
45 - Convalescent homes
5 - Medical transport services
531 - Rescue services
173 - Pharmacies and medical aid dispensaries 2 367
6ORGANIZATIONAL STRUCTURE OF VZP CZ
- Organizational structure is formed with the Head
Office, regional branches (14) and workplaces
(75) - Head Office executes decisions of the Supervisory
Board, it decides on activities of the insurance
company, it is responsible for cooperation with
state authorities, other bodies of the public
administration, with corporate and natural
persons, and it executes other activities that
are connected to the public health insurance - Tomorrow standard corporate governance will be
introduced during transformation to state owned
stock company
7VZP Guiding Principles for the future
Population scale public insurance
- Consumer centric
- Provider friendly
- Evidence based
- Transparency
Change from the tax office to the insurance
company is the biggest goal for the future
8VZP moves to
- Have common front end for all customer
interactions and standard repeatable processes
across locations - Real time claims submission, real time
eligibility and deductible status - Support of e-health, electronic prescribing and
chip EHIC - Centralized IT architecture and processing,
paperless transactions - employ empowered motivated and well trained people
9CHALLENGES
- Transformation from the tax office to the
insurance company - Insurance contracts with insured, selling
multiple insurance products - Possible integration with injury insurance, sick
funds even with disability payment
10Medical Challenges
- Ischemic Heart Disease, Smoking, HBP
- Tumors, Oncology diseases
- Diabetes and Obesity
- Demographics
11Where to go - Care management
- Horizontally integrated disease management
- Trend management on broad population
- Promotion of certification and standardization of
services, quality management
12COST DRIVERS
- Ageing population
- Drive for quality and higher comfort of care,
high expectations of population about delivery of
state of the art medical care - Care evolves away from treating acute episodes
towards chronic and/or expensive conditions - New expensive drugs incl. orphan drugs, genomics
and biologicals to treat these conditions - Technology improvements
13VZP Goal to Manage Health Care Costs is to Engage
- Patients (responsibility, multiple choice
products) - Providers (price competition)
- Medical societies (EBM)
- Producers (SCA, PVA, PPC)
- Employers (shared responsibility)
14Where to go
- Drive for quality
- Negotiate prices
- Make coverage decisions
- Adopt guidelines based on evidence and
comparative effectiveness and linking it to Pay
for Performance - Patient safety and information
- Incentives to promote healthy behavior
- Electronic records (EMR, EHR, PHR)
15Benefits Design to Manage Health Care Costs
- Deductibles and coinsurance
- Value based insurance
- Value based formulary
- Enablement of multiple product portfolios
- Integrating financial component into health care
product
16Thank You for Your Attention