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Health Care Marketplaces: They Work Overseas

As states across the nation prepare for their health care marketplaces to go live, it’s worth recognizing that some other countries already provide interesting examples of exchanges in action. Although the state exchanges have received a lot of media attention in the U.S. as far as potential impact and organization, the idea isn’t entirely new.In fact, exchanges are not completely fresh in the U.S., either. The eHealthInsurance website has been in operation since 1997, a living example of an electronic health insurance products sold in the individual market. Utah and Massachusetts also already operate their own forms of health insurance exchanges.
The drive to get all states on board with current health insurance exchange goals of operation by October 1, however, has been a challenge for some. There are several aspects of the existing and impending changes in health care reform that are similar to programs in other countries, which helps provide a window into the experiences and a basic guideline of what implementation might look like here. Two such examples are the Netherlands and Switzerland.
Mandating Universal Coverage With Basic Insurance Plans 
The Netherlands implemented this universal coverage mandate in 2006, built on their prior system of social and private insurance. The Swiss, too, have a mandate that has been in place even longer, since 1996. As a result, the numbers of uninsured individuals are low, and the government helps to subsidize about 40% of the population through premium assistance.
Regulation of Markets, Including Open Enrollment and Community Rating 
Guaranteed offer and renewal are both part of the systems in Switzerland and the Netherlands. The two countries each have their own approach, however, to setting premiums, risk equalization, and market oversight. The exchange program in Switzerland is region-based, much like how the U.S. system will operate.
  • In the Netherlands, plans operate on either a for-profit or non-profit basis. The top five plans make up 82% of enrollment. Children are provided full coverage through public funds. Plans generally offer coverage all over the country
  • The Swiss system is more decentralized, and only nonprofit insurers are allowed into the marketplace. The 10 largest carriers cover 80% of the population. 


National Standards For Coverage 

Benefits in both the Netherlands and Switzerland are comprehensive, with insurance systems combining working age and elderly populations into one pool. Switzerland has higher rates of cost-sharing. Individuals in both countries are highly likely to get supplemental coverage, which isn’t regulated by the same level of restrictions.


Successes Of Health Insurance Exchanges

Both the Swiss and the Dutch can lay claim to some success with their health insurance exchanges. Universal health coverage in both places has extended options to everyone, allowing a broad range of access and patient choice. Both countries also are connected with some of the longest life expectancies around the world, and the citizens in Switzerland and the Netherlands are also extremely positive about the health insurance exchange programs. The other benefit for the citizens in each country is that the government has taken an evolving approach to care, constantly seeking opportunities to improve the coverage and maintenance of the exchanges.

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