Insurers may limit specialist doctor choices: Council of State

The Council of States concluded in an advice to the First Chamber that the elimination of the so-called free choice of doctor is not contrary to European law. It is the citizen's choice to limit the choice of doctor to care providers who have a contract with the selected insurance companies.

The Senate added this extra advice because the legislative proposal, which eliminates the free choice of doctor, changed significantly with the consideration in the Second Chamber. After an interim agreement, the VVD, PvdA, D66, SGP and ChristenUnie supported the proposal in the Second Chamber.

The agreement states that insurers next year only need to pay for the care of medical specialists with which they have a contract. This does not include the so-called primary care such as house doctors. This means that citizens may choose any doctor, but if they are referred to a hospital, they have to look for a specialist that is reimbursed by the insurer.

The Council of State gives the government legal advice on legislative proposals before they are sent to parliament. The Senate wanted new advice from the Council of State for the purpose of the changes to the proposal since its submission to the Second Chamber. The central question was whether the elimination of the free choice of doctor is contrary to European law. Up until now, insurers had to reimburse all healthcare, even if the provider does not have a contract with the insurer.

"The right to compensation for non contracted care exists with acute care," the Council of State writes, "when the care or service is not available at reasonable time or distance from a contracted provider, when a contract with a provider is terminated but the treatment has not been completed, as well as when the health insurer does not timely notify with which healthcare providers they have contracts with."

The Council underlines that further development of the system of health insurance depends on adequate supervision by the Dutch Healthcare Authority (NZA) and the Authority for Consumer and Market (ACM).

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