The business reasonsfor international services
The reasoning why Pan-European data exchange in the Health Insurance Sector will be(come) beneficial
Budapest, May 10th 2011John StevensCZ (Dutch Health Insurance Organization)
Reasoning for setting up a business: Not that complicated !
My Grand Father’s proposition: His customers who:- have a need- are willing to pay for it
€
Selling price > Buying price
The supply market The demand market
The NETC@RDS proposition: Indeed, no vegetables but …..
The “demand market”
Insured/Patient’s needs:- medical problem to be solved- entitlement like at home- not being bored by forms, dedicated cards, cash payment
Patient’s insurer wants:- satisfied customer- cost effective procedures: . by preference national ID . no calls for E111 . no paper based reimbursement
The doctor wants:- doing his job- guarantee to get his money- no unfamiliar procedures
The national (Liaison)body wants:- no paper based invoices- no paper based copies of EHIC- no errors in data
Proposition 3*:
eBilling, providing all input for:- digital invoicing- automatic settlement of E125
The supply market:
Proposition 1*:
Online insurance verification, providing confirmation of entitlement, enabled by:- various portable documents like: (EHIC; eCards, ID- and Social Security Cards)- automatic capture of data
Proposition 2*:
Online eApproval, providing payment guarantee- digital “EHIC-dataset” (PDF and XML)
The NETC@RDS proposition: Indeed, no vegetables but …..
The “demand market”
Insured/Patient’s needs:- medical problem to be solved- entitlement like at home- not being bored by forms,dedicated cards, cash payment
Patient’s insurer wants:- satisfied customer- cost effective procedures:. by preference national ID. no calls for E111. no paper based reimbursement
The doctor wants:- doing his job- guarantee to get his money- no unfamiliar procedures
The national (Liaison)body wants:- no paper based invoices- no paper based copies of EHIC- no errors in data
Proposition 3*:
eBilling, providing all input for:- digital invoicing- automatic settlement of E125
The supply market:
Proposition 1*:
Online insurance verification, providing confirmation of entitlement, enabled by:- various portable documents like: (EHIC;eCards, ID- and Social Security Cards)
- automatic capture of data
Proposition 2*:
Online eApproval, providing payment guarantee- digital “EHIC-dataset” (PDF and XML)
Service proposition 1: Online Insurance verification, based on various portable documents
Who benefits, and to what extend ?
only 37% ofEU citizens
-100%- no need for a separate card
37% = 190.000.000 EHIC’s
€ 200.000.000,00 yearly
- Service experience- No additional stress- Feeling a real European
- Satisfied customers- Cost savings- up to date insurance status
Automatic data capture by OCR and/or SCR, currently operational forEHIC and eCards eEHIC)
- Time savings
The NETC@RDS proposition: Indeed, no vegetables but …..
The “demand market”
Insured/Patient’s needs:- medical problem to be solved- entitlement like at home- not being bored by forms,dedicated cards, cash payment
Patient’s insurer wants:- satisfied customer- cost effective procedures:. by preference national ID. no calls for E111. no paper based reimbursement
The doctor wants:- doing his job- guarantee to get his money- no unfamiliar procedures
The national (Liaison)body wants:- no paper based invoices- no paper based copies of EHIC- no errors in data
Proposition 3*:
eBilling, providing all input for:- digital invoicing- automatic settlement of E125
The supply market:
Proposition 1*:
Online insurance verification, providing confirmation of entitlement, enabled by:- various portable documents like: (EHIC;eCards, ID- and Social Security Cards)
- automatic capture of data
Proposition 2*:
Online eApproval, providing payment guarantee- digital “EHIC-dataset” (PDF and XML)
Service proposition 2: Online e Approval, providing payment guarantee and EHIC dataset
Who benefits, and to what extend ?
In case of no show EHIC: 2.557.000 calls for PRC
€ 22.000.000,00 yearly
- Service experience- No additional stress- Time (possibly cost) savings
- Satisfied customers- Time savings
- no need to call for a PRC- no need to pay cash- no need to apply for reimbursement
- automatic update patient file- EHIC dataset enabling eBilling- payment guarantee
- Time savings- Focus on his job, rather than being a bookkeeper
The NETC@RDS proposition: Indeed, no vegetables but …..
The “demand market”
Insured/Patient’s needs:- medical problem to be solved- entitlement like at home- not being bored by forms,dedicated cards, cash payment
Patient’s insurer wants:- satisfied customer- cost effective procedures:. by preference national ID. no calls for E111. no paper based reimbursement
The doctor wants:- doing his job- guarantee to get his money- no unfamiliar procedures
The national (Liaison)body wants:- no paper based invoices- no paper based copies of EHIC- no errors in data
Proposition 3*:
eBilling, providing all input for:- digital invoicing- automatic settlement of E125
The supply market:
Proposition 1*:
Online insurance verification, providing confirmation of entitlement, enabled by:- various portable documents like: (EHIC;eCards, ID- and Social Security Cards)
- automatic capture of data
Proposition 2*:
Online eApproval, providing payment guarantee- digital “EHIC-dataset” (PDF and XML)
Service proposition 3: eBilling, preventing from paper based invoicing
Who benefits, and to what extend ?
22.600.000 invoices to bereimbursed
€ 75.000.000,00 yearly
- Satisfied customers- Time savings
- dataset enabling eBilling- familiar/national procedures
- Time savings
- no longer copies of EHIC (and its dataset to be captured manually)- no longer paper based invoices (about 1 mln) to be transferred into E125
- Time savings
In summary: the reasoning for providing international services is based on 4 business cases:
no additionalEHIC emission
reduction:- calls for PRC- requests for reimbursement
eBilling - eBilling- auto. update patient file- data capture
Business cases
- national ID- no cash- no calls- no stress
Focus on job no disappointed customers
Bottom line:
No privatetariffs
200-300 mln
no dataerrors
not to apply for:- EHIC- reimbursem.
• Cost savings
• Time savings
• Fraud prevention/ cost containment
• Improvement of service quality
not quantifiable
>10 mln
Benefits
Costs
Annual costs for providing international services: € 155.000,00
30.000 calls for PRC € 260.000,00
400.000 requests for reimbursement € 3.500.000,00
PM:3.600.000 EHIC’s € 3.600.000,00
40.000 EHIC-related invoices (EU citizens in NL) € 350.000,00
Balancing costs/benefits from Dutch perspective:
BEP : 17.700 transactions
25.000 EHIC-related invoices (NL citizens in EU/MS) € 220.000,00
Although in the Netherlands we might apply another balance scale, I’m sure that …
Benefits
Costs
Benefits
Costs
…your scale will demonstrate positive outcomes as well
More information:
Report downloadable:http://www.netcards-project.com/web/bplan
To what extend the balance will tipp the scales in your country/region depends on:
Your country• Starting position country
. health infrastructure
. online services
. portal provider
. business model
. costs for international
service to be calcula-
ted as marginal costs
• Entrepreneurship
• HIO’s back offices connected
• “Customers” (HIO’s) willing to pay for international services
European Commission• Willingness to allow
Member States on voluntary basis to pilot with EHIC substitutes
• Willingness to work towards mandatory online insurance verification
• Encouraging MS’s Liaison bodies to accept downloaded EHIC dataset/PRC’s as payment guarantee
(to be provided in SED format)
Fellow member State• Health infrastructure
available?
• HCP’s connected to infrastructure, and able to make use of online services
• HCP’s willing to use
the cross border service
