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Pay for performance: the start Agis health Insurance Company

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Mandatory system health insurance for basic benefits package ... Mandatory heath insurance system. Based on solidarity (Dutch societal values and norms) ... – PowerPoint PPT presentation

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Title: Pay for performance: the start Agis health Insurance Company


1
Pay for performance the start Agis health
Insurance Company
Aldien Poll Strategic consultant Quality
Innovation Agis Zorgverzekeringen
2
content
  • Part 1 Dutch healthinsurance system in
    brief Aldien Poll 10 minutes
  • Part 2 pay for performance in physical
    therapy Piet Stam 30 minutes

3
Laws in the private market of healthcare
  • Mandatory system health insurance for basic
    benefits package
  • Supervision by the Healthcare Authority on the
    market system
  • Supervision by the Government on minimal
    Quality of care
  • Responsibility of insurers for value based
    purchasing

4
Tariff regulation and free negotiations
(providers market)
  • Free tariffs for 50 of care delivered by
    individual providers
  • Tariffs for 80 of institutional care (hospitals)
  • Tariffs for 20 of institutional care are
    deregulated in negociations with HIC

5
Insurance premiums (insurance market)
  • 50 based on income and 50 nominal premium (for
    basic benefits package)
  • Every insured pays the same nominal premium in
    the same policy per insurer
  • Employers make the compulsory income related
    payments
  • An insurer can offer different policies
  • Goverment will pay premium for children under the
    age of 18

6
Insurance premiums (insurance market) (2)
  • Insured pay their part of the premium directly to
    the HIC
  • Employers pay their part of the premiums to the
    Risk Equalization Fund
  • HICs are compensated by risk equalisation
    payments from the Risk Equalization Fund
  • Based on the risk profile of their insured

7
Heart of the dutch system
  • Mandatory heath insurance system
  • Based on solidarity (Dutch societal values and
    norms)
  • Enforced by Risk equalization among insurers
  • To prevent risk selection (and their adverse
    effects)
  • And create a level playing field for insurers
  • With equal premiums for everyone within one policy

8
Risk Equalization parameters Diabetes (n
60.000) Compensation of predictable costs due to
risk profile
9
Agis Health Care Insurance Company
  • Agis 9 marketshare
  • Nominal Premium 1100
  • Merger with Eureko 25 marketshare

10
Managing healtcare costs by value based purchasing
Healthcare
insured
Health-risk
complaints
Diagnosis
Therapy
Efficiency Improve- ment Pay for Performance
Risk- manage- ment
Proces- manage- ment
Feedback
HIC
Feedback
payments
Premium
11
Value based purchasing
  • Risk equalization is a necessary pre-condition!
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