Large insurers limiting free choice of doctor by scrapping reimbursement policies

Three major health insurers - Zilveren Kruis, CZ, and Stad Holland - will no longer offer reimbursement policies next year. This type of policy is an important pillar of the free choice of doctors - it always fully reimburses care from any healthcare provider, whether or not they have a contract with the insurer, the Volkskrant reports.

Of the major insurers, only Menzis will still have a reimbursement policy in its portfolio in 2024. VGZ stopped it last year. Small insurer ASR keeps its reimbursement policy. Aevitae had two such policies last year and will offer one in 2024. All in all, Netherlands residents will have three reimbursement policies to choose from next year, compared to seven in 2023 and 11 in 2022.

“Not a good development,” the Patient Federation told the Volkskrant. Many patients prefer a reimbursement policy to retain control over which healthcare provider treats them. “For example, in the case of a rare condition or a special personal situation,” the organization said.

Hans Buijing, chairman of Zorgthuisnl, a trade association with many community nursing organizations as members, called the reduction of reimbursement policies a “devious move” to reduce the free choice of doctors and “essentially a bad thing.” He says uncontracted healthcare providers will lose customers because health insurers don’t cover them. “I strongly feel that health insurers want to push parties out of healthcare. More and more healthcare providers are already leaving community nursing,” he said.

According to Aad de Groot, board chairman of DSW and Stad Holland, the discontinuation of the reimbursement policy is due to a decision by the Dutch Healthcare Authority several years ago. “At the time, the concept of ‘market rate’ - rates that we are forced to reimburse - was defined far too broadly.” Now, for example, an independent clinic can charge the rate of an academic hospital for a simple knee surgery. If the patient has a reimbursement policy, the health insurer must pay it.

The high reimbursements lead to enormous cost increases, especially in mental healthcare, De Groot told the newspaper. “We must always reimburse reimbursement policyholders the maximum rate. Some providers already state on their website that they only treat customers with reimbursement policies.” It leads to excess, he said, referring to one provider in particular - Stad Holland had 10 percent more patients get treatment from that provider this year. But the reimbursement amount more than doubled from 25 million euros in 2022 to 55 million euros this year.