Ineffective treatments to be removed from basic health insurance package

Treatments that have not been proven effective will be removed from the Netherlands' basic health insurance package, national healthcare institute Zorginstituut Nederland (ZN) announced on Monday. A "results agreement" will be made for treatments where there has not been clear scientific evidence to prove the programs work as promised. If proof of the treatment's effectiveness is not provided, it will disappear from the basic insurance packages, ZN chairman Sjaak Wijma said in an interview with AD.

The organization was expected to provide advice on the issue to the Cabinet on Monday including criticism against sleep centers in hospitals, for what Wijma called a lack of "scientific substantiation", and a drug combination used to treat renal cell cancer which ZN said does not show a clear improvement to survival rates. ZN was likely to also provide positive recommendations for several expensive medicines, including a combination of the drugs trastuzumab and emtansine, used to treat women with hormone sensitive metastatic breast cancer, and esketamine, a nasal spray which can treat severe depression in patients who do not respond to therapy, the newspaper reported.

According to Wijma, the discussion around the basic health insurance package is currently too focused on new and expensive medicines that qualify for reimbursement. And in the meantime, research showed that about half of the treatments already covered in the package is not scientifically proven, he said. "That is why it is important that we find out and assess what works and what does not."

"We have been too reticent about this in recent years," he said, noting the political controversy which arises whenever a treatment is eliminated from coverage like when ZN pushed to eliminate high altitude therapy for asthma sufferers who are sent to Davos, Switzerland for treatment. "But at the same time there is pressure on the rising costs. If you do nothing, non-sensible care will never disappear. ”

Healthcare costs in the Netherlands are continuing to rise. In the 2021 national budget, 87 billion euros is dedicated to healthcare. Keeping care affordable with these rising costs and without looking at whether that money is being spent properly, is not a viable path, Wijma said. "We already pay an average of 6 thousand euros per Dutch person on healthcare. If we do nothing to stem healthcare costs, we will pay half of the tax money on healthcare by 2040. That is a no go area," he said to the newspaper.

Scrapping ineffective treatments is also good for the patient, he added. "As a patient it is also better to receive efficient care. The fact that non-meaningful care is disappearing from the package is not at all bad for patients."

Removing treatments from health insurance is always a controversial topic. Last year, the ZN advised that high mountain treatment for asthma patients in Davos, Swizterland, be scrapped because it had no added value. This led to an uproar among patient organizations and in parliament.

One of the treatments ZN will now be looking at is sleep centers for people with sleep apnea. Many hospitals have set up such sleep centers. "A lot of people and resources are spent on this, but the scientific basis may be very narrow," Wijma said.

“In recent years, sleep centers have been established in many hospitals for people with obstructive sleep apnea, or people who stop breathing in their sleep. A lot of people and resources are spent on this, but the scientific basis could be very tight. We are not saying that these treatments will be removed from the package, but that will happen if there is no scientific substantiation. ”