Comparison of Health Insurance systems

between Netherlands and Russia Federation

Final essay
Botea Cristina, Gyrfi Edina-Master IBA, 2 year
20-01-2016

Comparison of Health Insurance systems

between Netherlands and Russia
when health is absent, wisdom can`t reveal
itself, art can`t become manifest, strength
can`t fight, wealth becomes useless and
intelligence can`t be applied.

We can never start too early to take care of our health. We chose this topic because the insurance
issue is a vital element of the economic sector and an essential component of people welfare.
Life is always uncertain and risky we can never know what future brings to you. Instead of
stressing yourself with unpredictable situations that can put your life in danger, a health
insurance could be a solution to this problem. Nowadays there are numerous different types of
health care systems run by different governments. We choose to emphasize the main features of
two different countries health care systems in Netherland and Russia.

Health insurance in the Netherlands

Everyone living in the Netherlands is legally obliged to have health insurance, whether the Dutch
public health insurance or private health insurance.
Most expats living in the Netherlands long term will be eligible to apply for the Dutch public
health insurance but if youre not, or you want to take out extra cover, then youll have to take
out private health insurance.

Dutch public health insurance

Public health insurance in the Netherlands is divided into two forms:

The basic insurance package known as Zvw (Zorgverzekeringswet) covers most

healthcare from GPs and hospitals, and is mandatory for all legal residents in the
Netherlands including expats even if you already have health cover in your home

country. Insurance companies have to offer the same basic policy to everyone regardless
of age or state of health.

The second scheme WLZ (Wet langdurige zorg), which replaced the AWBZ (Algemene
Wet Bijzondere Ziektekosten) in 2015, covers long-term nursing and care treatment and
is automatically provided and funded by deductions from the salary.

Who must obtain Dutch health insurance?

EU/EEA and Swiss citizens and their families living for more than a year in the Netherlands
need to take out the Dutch public health insurance; retirees may be covered by health care cover
from their home country. European Health Insurance Card (EHIC) holders can use the card for
healthcare in the Netherlands for up to a year but may have to pay up front and claim the money
back later.
Non-EU citizens staying for longer than three months will need a residence permit, after which
they are required to take out the Dutch public health insurance. Some people may need to take
out

private

insurance,

depending

on

personal

circumstances

or

illnesses.

Students under 30 who are studying but not working (not even part-time) nor in a paid internship
do not qualify for Dutch health insurance and have to take out private insurance unless covered
by insurance back in their home country. Over 30s who are employed or staying for more than
one year have to take out the Dutch health insurance.
Children under 18 are covered for free under their parents' health care insurance.
For more information about eligibility, what care and treatments are covered, how the insurance
is funded, the excess and help with costs, see our comprehensive guide to the Dutch healthcare
system.
Private health insurance in the Netherlands
If you are not covered by the Dutch public health insurance or you want to take out cover for
extra treatments (for example, physiotherapy or extensive dental treatments), then youll have to
take out a private health insurance policy. Private policies can also offer access to private
facilities

so

you

can

get

treatment

sooner

than

through

the

state

system.

Unlike the basic insurance policy, insurance companies are not obliged to accept you for private
insurance, and your age and health condition can have an impact.
How to choose a Dutch insurance provider
You are free to select a basic insurance provider of your choice although it can be difficult to
choose between different insurers as many of their sites are in Dutch, which, even with online
translators, can be tricky to read. You can start by looking at comparison sites (for
example, www.independer.nl or www.kiesbeter.nl) in order to find one best suited to you and
your family, taking into consideration price, what is covered, and how much is the excess
payment (the amount you co-pay for certain treatments).
Bear in mind that some employers also offer corporate health insurance for employees, which
may be cheaper than taking out a policy individually.
It is possible to purchase additional coverage (aanvullende packet) from a different insurer than
your basic insurer. This may complicate processing your bills, but it can sometimes lower your
overall costs or allow you to purchase additional coverage tailored for the needs of international
residents in the Netherlands.
You can change your policy every year before 1 January, so its worth checking to make sure the
insurance policy youve got still meets your needs.

Achmea Insurance
Aegon
Agis Zorgverzekeringen
DSW Zorgerzekeraar
Menzis Zorg en Inkomen
ONVZ
Univ Verzekeringen
VGZ Zorgverzekeraar Insurance

What to look for in a basic policy

How much is the premium?
How does the policy work? There are three types:

a policy in kind, where the health insurer has contracts with specific health providers and
pays the bills for any treatment directly to them;

a restitution policy, where you choose your health provider, pay for treatment upfront
and get a refund from the insurance company afterwards;

a combination policy where part of the bill is paid by the insurer and part by you.

What is the excess (the part of the cost that you have to pay yourself)? This could be nothing or
as much as EUR 500. Increasing your excess (eg. up to EUR 850) can be a way to lower your
monthly payments.
Do you have the option to take out supplementary insurance for any care or treatment thats not
included in the standard package?
What to look for in a private insurance policy?
Look carefully at individual packages to find the one that provides the best cover for you and/or
your familys personal circumstances.
Do you have any pre-existing conditions?
Do you have children?
Do you plan to travel abroad regularly and need coverage for any medical emergencies?
What are the premiums and excess?
How to apply for Dutch health insurance
You have four months to take out insurance after arriving in the Netherlands. If you fail to do so,
you could face a fine, and be billed retrospectively for the time you were uninsured.
When you register with a health insurer, you will be asked to provide your Citizen Service
Number (burgerservicenummer or BSN).
4

This may be issued to you by your employer or by application from the municipal authority
where you live or from the Dutch Tax and Customs Administration (Belastingdienst). Youll also
need to provide proof of residence in the country, as well as an ID document such as your
passport and a letter from your employer confirming your employment. The most common
method of registering is to either contact the insurer online or by phone. Insurance policies are
valid from the time you pay your very first premium.
How to use your Dutch health insurance
Whenever you seek medical treatment or purchase prescriptions, you must present your ID and
health insurance chip card (issued by your insurer). Whether you pay upfront for treatments and
claim back from the insurer or the insurer pays the health provider directly depends on your
policy.
There is a state-set excess amount (or deductible) which you must pay towards your healthcare
costs each year, which is revised yearly by the government. In 2015, the amount was set at EUR
375.
At the end of each year the government announces next year's basic insurance premiums and you
have the right to change insurer once a year, provided you inform them of your intention to
cancel prior to 1 January.

Health Insurance in Russia

There are two primary types of health insurance in Russia:

The compulsory insurance known as OMC. It is provided by the state and is provided
free to Russians, but many vital treatments and procedures are not covered by the
compulsory plan. In addition, OMC applies only to treatments at a specific hospital; if a
person covered only by OMC become ill while travelling, even within Russia, he or she
will not be covered by OMC, and will have to pay in full for medical services, except in
emergency cases that require calling an ambulance.

Privately purchased medical insurance, or DMC.

For this reason, people from abroad, including international students, are encouraged to purchase
private health insurance in Russia. International students should consider purchasing medical
insurance in Russia that covers both medical care in Russia, and medical evacuation back to their
home country. It is generally wise to check to make sure your insurance policy covers medical
evacuations before your stay in Russia, as medical evacuations are very expensive. In some
cases, however, they are the only option, as the quality of Russian medical care varies throughout
the country. Most patients from abroad pay for medical services in cash and receive
reimbursement from their insurance company upon their arrival back home.
All insurance companies, whether private or state-owned, sell health insurance in Russia to
individuals, whether they are Russian citizens or not. In spite of this, private health insurance in
Russia is not yet commonly held by individuals; it is mostly bought by large companies in order
to insure their employees. This medical insurance in Russia covers medical care in a large
number of cities and includes inpatient and outpatient treatments, doctors fees, diagnostics,
drugs, and transportation by ambulance, as well as various other costs.
The price of private health insurance in Russia varies from 10,000 to 45,000 rubles per year,
depending on the number of medical establishments and services included in the plan. In the
event of a medical emergency or accident, a patient covered by health insurance in Russia should
call his or her insurance provider, and an operator will advise him or her on the necessary
medical procedures. Even private medical insurance in Russia has exceptions, however; for
example, no insurance policy available in Russia will cover pre-existing conditions or terminal
illnesses. Because of this, many people choose to use their free OMC policies to cover basic of
real emergency, so they can pay this doctor directly, thereby saving money and ensuring that
medical services, and find a doctor with whom they can develop a personal agreement in times
they receive the proper care. Some countries, such as Britain, have reciprocal health care
agreements with Russia. This means that because Britains health insurance is valid in Russian,
British nationals do not need health insurance in Russia. It is still recommended, however, that
foreign nationals travelling in Russia, including international students, to purchase private health
insurance that will cover treatment in Russia before entering the country.

Life expectancy 1990-2015 Netherland vs. Russia

2015

2010
Russia-female

2005

Russia -male
Netherland-female

2000

Netherland-male
1995

1990
0

10

20

30

40

50

60

70

80

90

In the Russia Federation the life expectancy differs, we have an increase from 1990-2005 and a
slight decrease from 2005-2015 for both female and male due to low standard of living. During
the period of 1990-2013 it only grew by 1.8 years in Russia, while the global average number
increased by 6.2 years, pushing Russia out of the top 100 countries with the highest life
expectancy and placing it in 122th position while Netherland is placed in the top 20 countries of
life expectancy. The situation will most likely worsen in the years to come, said experts.
Economic crisis, lower incomes and deteriorating quality of life in Russia will eventually have
their impact on health and, therefore, overall life expectancy. In Netherland we have a constant
increase from year to year, due to economic stability and government implication.
An important factor that affects the healthcare system is GDP/capita and government budget
health expenditure, described in the table below:
Health expenditure
Health.Expend.
M.$
66.912 $
Russia
Netherland 82.910 $

H.Expendi. %
budget
8.42%
20.67%

Health.Exp./Capital GDP/Capital
466 $
4927 $

12.735 $
52.172 $

As we can see on the table above there is a huge difference in how the government allocates the
budget for the health care system. There is a difference of 15.998 $ of the Health expenditure
between both countries which represents also a difference of 12.25% of the health expenditure
budget. We can see another gap in health expenditure/capital, Netherland spend ten times more
than Russia. Similar difference we can see in GDP/Capital. Numerous empirical studies have
shown that total health spending generally increases as the GDP increases.

Conclusion
Delivering high quality health care to all citizens for a reasonable cost should be a simple thing.
Unfortunately, it is not.
Netherland has a very well structured health care system and the government allocates a big
percentage from the budget for it. On the other hand Russia needs to improve their health care
system to reach the European standards. Improving health outcomes by implementing new
policies and reforms can help Russia to solve their health challenges. There is no country with a
perfect system, however many operates significantly better than others.

Bibliography
http://www.who.int/gho/countries/en/#N
https://en.wikipedia.org/wiki/Healthcare_in_Russia
http://unstats.un.org/unsd/tradeserv/db/docs/Doc47-CPM-091-Berlin-ISI.pdf