Going private?

Statutory health insurance, sickness funds and the development of private health insurance in the Netherlands 1910-1986

R.A.A. Vonk

Centre for the history of health insurance, dept. Medical Humanities

Centre for the history of health insurance, dept. Medical Humanities

Centre for the history of health insurance, dept. Medical Humanities

- If and in what way sickness funds have influenced the private health insurance market during the period 1910 - 1986

Centre for the history of health insurance, dept. Medical Humanities

1900

- Poor Law (no income)

- Sickness fund insurance (low income)

- Out of pocket payment (middle/high income)

1910 – 1940

- ± 1910: private health insurers (comp. plans)

- 1912: binding resolution NMG

- 1910-1930: high failure rate and “malpractices”

- 1930: hospital plans

- Sickness funds as moral example

Centre for the history of health insurance, dept. Medical Humanities

Centre for the history of health insurance, dept. Medical Humanities

1941 – 1946

1941: Introduction of social health insurance

- compulsory (wage earners)

- voluntary (non wage earners)

- SHI schemes and PHI separated by an income limit

Centre for the history of health insurance, dept. Medical Humanities

Sickness Fund Decree: repercussions

- PHI-companies lose major part portfolio

- Sickness funds start to offer suppl. insurance

- Sickness fund prohibited to provide PHI

Centre for the history of health insurance, dept. Medical Humanities

1947-1969

- Expansion social health insurance (income limit)

- 1947: Bovenbouwers (PHI related to sickness funds)

- Sickness funds and private insurers against national

health insurance

- 1957: ANPZ-policy and VVBR risk-pool

Centre for the history of health insurance, dept. Medical Humanities

1947-1969

- 1962: KLOZ (umbrella org. private health insurers)

- Plans to reform health care sector (BVV/AWZ)

- Bovenbouwers and insurers join forces

- 1967: NOZ risk-pool

Centre for the history of health insurance, dept. Medical Humanities

Centre for the history of health insurance, dept. Medical Humanities

1971-1980

- No immediate threat National Health Insurance

- Escalating risk segmentation / premium differentiation

- Skimming voluntary social health insurance

- Bovenbouwers apply entrepreneurial principles

Centre for the history of health insurance, dept. Medical Humanities

1971-1985

- 1971: Zeven pijlers-plan

- 1974: Restructuring effort

- 1986: WTZ- Dissolving voluntary social health insurance

- Socializing private health insurance

- Standard policy

- Compulsory acceptance

- Fixed premium

Centre for the history of health insurance, dept. Medical Humanities

Centre for the history of health insurance, dept. Medical Humanities

Conclusions

- Moral example

- “socialization” through competition (1960’s)

- SHI-principles enter PHI

- Failing self regulation (1970’s)

- PHI-principles enter SHI (bovenbouwers)

- Government intervention (1980’s)

Thank you, for your attention