Private Health Insurance and the European Union by Unknown

Author:Unknown
Language: eng
Format: epub
ISBN: 9783030543556
Publisher: Springer International Publishing

2.2 The Recent Surge in Complementary Health Coverage and the Growing Presence of Insurance Companies

The difficulty of imposing systemic healthcare reform and the relative ease of introducing cost-containment measures are not necessarily contradictory. The combination is a recurrent feature of Bismarckian systems, as compared to Beveridgean systems. It is indeed well established that in Bismarckian systems, reforms tend to combine retrenchment measures with the continuation, expansion and improvement of existing programmes (Bonoli 2001). In Belgium, this broad development was amplified by some of the structural features of the country’s heavily fragmented constitutional system, characterized by numerous veto points—a fragmentation reflected in the overall organization of the healthcare system as well.

The persistent influence of mutual benefit societies combined with cost-containment policies adopted between the 1980s and 1990s resulted in singular developments. From the 1980s onwards, several mutual benefit societies started offering complementary health coverage—a situation that generalized during the 1990s. Due to their position in the provision of health insurance under the statutory regime, these complementary plans, though legally voluntary, became de facto compulsory for individuals affiliated with a mutual benefit society. Complementary health insurance emerged in Belgium without any formalized legal boundaries or defined coverage, which significantly varies from one provider to the next. Another peculiarity of complementary health insurance in Belgium is that it does not solely reimburse the share of health expenditures that is not covered under the statutory regime, as is most often the case with complementary health insurance (Mossialos and Thomson 2004). In line with the values of “social inclusion” and “solidarity” claimed by mutual benefit societies, a large array of benefits and services are covered in addition to the partial or full reimbursement of co-payments. These include, but are not limited to, medical transportation, home care, equipment leases in case of disability, reimbursement of homeopathic medicines, childbirth benefits and financial support to join a sports club. The fees and benefits covered significantly vary from one mutual benefit society to the next.

More importantly, mutual benefit societies offer “small” risk coverage for the self-employed (such as visits to a general practitioner), who were not included in statutory insurance until recently, as well as hospital care—essentially offering superior accommodation rather than increasing choice or providing faster or better access (Thomson et al. 2013). Until the beginning of the 2000s, larger mutual benefit societies thus developed increasingly large and complex complementary health coverage. Their offers, also increasingly integrated, embrace lower statutory coverage in some areas, especially hospital care.

A prominent example of this trend is the case of Christian mutual benefit societies, which covered around 45% of the Belgian population (Lewalle 2006) by the early 2000s. As a growing share of their affiliates faced difficulties coping with out-of-pocket expenditures in hospital care, these societies created a whole complementary service called Solimut. Through this entity, they created a system of deductibles that members would need to pay for hospitalizations, based on a deductible per hospitalization as well as an annual deductible per family, independent of the number of hospitalizations. This complementary scheme covers all co-payments, supplements, drugs and medical devices (e.

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