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Private medical insurance in the European Union – CEA Insurers of Europe 2011

Executive summary s. 5

Significant diversity exists in the private medical insurance (PMI) systems in the European Union (EU), but they can be divided into four categories:

Three are voluntary PMI schemes:

• additional (complementary or supplementary) PMI;

• substitute PMI; and

• duplicate PMI.

The fourth category is

• mandatory, of which the only existing scheme in the EU is in the Netherlands, where it can be sold jointly with supplementary PMI.

PMI offers the following benefits:

• Consumers receive better access to healthcare and are offered better quality care as well as a higher level of reimbursement than with public healthcare systems.

• Compared to public healthcare systems, PMI offers consumers more freedom of choice (eg. when treatment takes place, by which specialist and in which hospital or clinic).

• Private medical insurers manage risks more efficiently through the pooling of risks.

The advantages of mandatory PMI s. 12

The rules set by the Dutch government have resulted in intense competition between private medical insurers, which in turn has led to cost control, ie no premium increases. There is a level playing field between all private medical insurers. Insurers strive to offer good quality healthcare services at low premiums. Indeed, although making profits is allowed, competition for market share keeps any profits low. Dutch private medical insurers thus contribute to a sustainable healthcare system and satisfy a growing demand for healthcare services in a sector with historically rising costs that used to be almost entirely public.

IV.3 Risk assessment and actuarial calculations s. 13

In individual and small-group insurance, PMI spreads the risk of an individual with other individuals over time. Differentiating between various risks on the basis of a comprehensive risk assessment is vital to PMI and beneficial to consumers. In other words, insurers treat equal and comparable situations equally, and different situations differently. When insurers are able to price applicants accurately, it is the consumers who eventually benefit from fair prices and a more competitive industry. Prohibiting the use of risk factors inhibits the industry’s ability to price products fairly and accurately and to provide broad insurance cover.