7 Lessons on the Growing Popularity of an Additional Plan for Outpatient Care Costs

To many employees today, good hospitalisation insurance, offered by the employer, is almost taken for granted. Good hospitalisation insurance is an important financial safety net in case of major medical costs. Nevertheless a significant part of the healthcare expenditure is borne by the patient. Figures from Assuralia show that nearly a fifth (19.1%) of the total healthcare expenditure in 2018 was ultimately borne by the patient. ‘Over two thirds of these expenses (68.4%) are outpatient costs’, Koen De Moor specifies. ‘For dental care and pharmaceutical aid or medical products, the proportion to be ultimately paid by the patient is the highest.’

To gain a better insight into the added value of outpatient care plans, Vanbreda Risk & Benefits carried out extensive sampling in its portfolio of insureds with an outpatient care plan. It shows that employers have already realised the need for outpatient care plans. In 2011, one in seven employers in the portfolio had taken out an outpatient care plan for their employees. In ten years time this percentage has more than doubled, to 34% in 2021, as Vanbreda concludes. ‘The wheel has been set in motion’, Evelyne Lauwers confirms. ‘In terms of type of coverage, we further see that employers increasingly opt for a full outpatient care package, which also includes reimbursement for optical and dental costs.’

The analysis by Vanbreda Risk & Benefits also shows that the average cost submitted by an adult for expenses covered by an additional plan for outpatient care costs is 360 euro per year. For children it is approximately half of this amount. ‘Nearly a quarter of the 360 euros of outpatient care costs that is annually submitted refers to a medical consultation or performance’, says Evelyne Lauwers. ‘Another quarter refers to pharmaceutical or parapharmaceutical costs.’

When searching for developments to explain the increased importance of outpatient care plans, it is obvious that we need to consider the shift from hospital admissions to outpatient care. Medical treatments, procedures and examinations are more and more often offered on an outpatient basis rather than being carried out in hospital. This means that part of the medical costs that the patient used to get reimbursed through the hospitalisation insurance are no longer covered. ‘Treatments, procedures and examinations without hospital admission have a financial impact on the patient’, says Koen De Moor. ‘Medical progress reduces the costs that a standard insurance package could previously reimburse.’

The enhanced focus on prevention and well-being further explains why the proportion of outpatient care costs is on the rise. Families are becoming increasingly aware of the importance of a good health and a healthy lifestyle. As a result, they more often find their way to professional help. ‘The pandemic has merely further underlined the significance of good health’, Evelyne Lauwers states. ‘That is why people more quickly seek help from psychologists, dieticians, podiatrists or speech therapists nowadays. Logically, the demand for vaccination is likely to increase as well.’

Last but not least, dental care more often than not plays an essential role in the decision whether or not to take out an outpatient care plan. As mentioned before, these dental costs are first on the list of costs that continue to be borne largely by the patient if no outpatient care plan is in place. A look at the costs shows that dental costs for adults represent 25.5% of the total outpatient care costs. For children this is 30%. A major part of the costs for adults (62.5%) can be attributed to dental prostheses (fixed or removable). The largest expenditure on dental care for children is with respect to orthodontics (85%). ‘Not surprising, because orthodontic procedures and dental prostheses have a high price tag’, says Koen De Moor. ‘Since 2021, various health insurance funds have been offering their members an increased reimbursement for this but even that often proves insufficient.’

The reimbursement for dental care is typical of the evolution of the additional plans for outpatient care costs. Whilst in 2011 a full outpatient care package, including reimbursement for optical and dental costs, still accounted for about half of the existing outpatient care plans in the Vanbreda Risk & Benefits portfolio, this share has increased to more than 75% in 2021. ‘These figures illustrate that an outpatient care plan has become more than a mere expensive option’, Evelyne Lauwers concludes. ‘Thanks to this coverage, many employers manage to offer real added value to their employees.’