Visit Chinese delegation

Care purchase

by

Jan Taco te Gussinklo

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 Visit Chinese delegation

• The health care insurance market

• Procurement: theory & practice

• It’s all about consumer empowerment

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 The ‘old’ system

l th
e a
h e
l ic nc l th
b ra a
Supplementary insurance
u
P su he
in t e ce
va an
i r
Pr su
Insured in

AWBZ

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New system since 2006 01 01

Basic health insurance

Supplementary insurance

Insured

AWBZ

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 Costs go up
More s enio rs 65+
Technolo gy
Per centa ge 65+:
now 14 %
Pressu re on
→ 23 % in 2040
eco nomy Tens io n
on labo ur mark et.
Health Care Cost:
no w 9,7 % →
14% in 20 40 Per forma nce of
the health ca re
syst em ha s to
go up

5  
 Who is paying the health system?

Income related premium Government

employer 50% controlled
Risk/Cost
Tax money sharing
government procedures
5%

Consumer allowance
Flat rate insurance premium
45% Insurance
customer
company

claims
Health
providers

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 What happened last year?

• 1942 German system was ended.

From now: everyone in the same, obliged basic
insurance package.

• Huge shift of insureds (25% changed from insurance

company)

• Growth of collective contracts (employers, unions,

affinity groups)

• Strong price (premium) competition leading to cost

pressure on the insurance companies

• Zero sum game?….. (M. Porter)

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 What business are we in?

Achmea health care procurement

Some facts & figures

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 Traditional Procurement Process

Tactical: Operational:
frame agreements procure to pay processing

Specify Select Contract Order Control Pay &

Needs Supplier Supplier Delivery after care

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 The market of contracting

• Moving from regulated towards more market-oriented

• Mergers insurance companies: 10 insurers have 90% of

the market

• Fragmented suppliers market

• Complex, uncoordinated governance of the market

• Complex market-entries (barriers)

• More price- than quality-oriented competition

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 contracts

hospitals 120
pharmacies 1600
Family doctor 7500
supplies 2000
transport 10
Birth/maternity 150
paramedic 12000
dental 6000
other 500

total 29880

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 Impact Finance

Procurement volumes

Estimates 2006 (€ mln)

2006 (€ mln)
Supplier market
Approx

Hospitals 2.700
Local / personal doctors aid 333
Fysiotherapists etc. 180
Dental 285
Pharma 921
End user equipment 240
Birth services/ maternity care 70
International services (mainly hospitals) 17
Transport 92
Business Clients specific services 8
Short term mental aid / hospitalisation 515
Total 5.361

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 Changing landscape

Transformation focus:

“secure nation wide, for all our

customers just in time availability
of high quality, affordable health
services”

“ performance level of the health

system and its members must go
upwards !

Collaboration between the

members is crucial. Otherwise
conflicts will probably drive up the
costs and drive down the quality‘

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 Our strategic goals:

1. High quality and cost control (and predictability)

2. Operational excellence
3. Improved customer focus (demand driven procurement)
4. Good supplier relations(management)
5. Competent and involved employees

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 Options for the future

Health &
wellbeing
Value
impact

Quality

availability

coverage

Consumer intimicy

• We guarantee financial • We guarantee financial • We guarantee availability • We integrate health with

coverage of costs of all coverage of costs and
basic health services availability of all basic
• Financial health services
value concept • Financial en logistical
value concept
of group wise costumized other comfort, well-being
healt services and security etc. services
• Quality value concept (income, health, sucurity,
pensions, housing etc.)

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 A few issues to consider…

• Free choice of health care supplier by the insured

• Health & prevention vs illness

• Cost containment (low premium) vs the best care for the

patient (two faces)

• How to navigate the patient

• Information asymmetry

• Relation doctor – patient vs Relation insurer - insured

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