WEEK4 Flashcards
Rationing in the Netherlands > tax-funded healthcare acts
- Public health act: individual and collective prevention
- Social support act (Wmo): providing support to people
- Youth act: support and care for young people
Tax-funded healthcare acts are funded by the national government and implemented by local authorities
(pros & cons)
+ objective distribution key
+ early signaling care needs
+ co-payments
- municipality has own budget > inequal
- co-payments are income-independent
- increase in waiting times
Insurance-based healthcare acts are enforced by the government and implemented by policy makers, insurers and providers
(pros & cons)
+ co-payments may reduce moral hazard
+ equal access
+ healthcare allowance (zorgtoeslag)
- flexible budget
- trade-off between equity and efficiency
- stakeholders with different ideas
Demarcation of basic benefits package (BBP)
selection
assessment
appraisal
policy decision
Stage 1: Selection
Horizon scan for Medical Products
- ZIN selects outpatient
- Ministry VWS selects inpatient
Stage 2: Assessment
4 decision criteria
1) necessity: can patient pay for it out-of-pocket? + QALY-berekening
2) effectiveness: being evidence based & belonging to area of expertise
3) cost-effectiveness: ICER
4) feasibility: possible & sustainable
what is the impact on the…?
- healthcare workforce
- climate and environment
- organization of healthcare
- budget
Reasons for including cost-ineffective pharmaceutical
- no alternative available
- important innovation
- treat patient with rare disease
Reasons against including cost-ineffective pharmaceutical
- cosmetic improvements
- lifestyle improvements
- can be paid out-of-pocket
Stage 3: Appraisal
At ACP there are cases in which there is doubt about whether to reimburse or not
- uncertainty about long term effectiveness
- high asking price
- is product really innovative?
Patents (reason & consequences)
Without patents there are no incentives to innovate
>
without large pharmaceutical companies there would be no pharmaceutical innovation
>
pharmaceutical innovation is crucial for improving population health
Economic consequences of monopolies
- Barriers to entry > long-run economic profits
- Unlike short-run profits
- Wealth from consumers to monopoly
Economic consequences of patent system
- Increases costs for innovation
- Protect patents
- Rent seeking
Insurance-based healthcare acts in The Netherlands
- Long term care act (Wlz): vulnerable groups
- Health insurance act (Zvw): curative health services
