Diederik Schrijvershof and Leah Peeters are representing Stichting De Bevlogen Huisartsen (“DBH”) and 71 general practitioners in proceedings before the Trade and Industry Appeals Tribunal (“CBb”) against the Dutch Healthcare Authority (“NZa”). The case concerns the NZa's failure to enforce the statutory duty of care of all healthcare insurers in both mental healthcare and general practice.
Dutch citizens are obliged to take out basic healthcare insurance and pay compulsory health insurance premiums to healthcare insurers. Healthcare insurers have a statutory duty to procure sufficient care for their compulsorily insured persons. The latter follows from the statutory duty of care (Article 11 of the Health Insurance Act) that rests with every healthcare insurer. In both mental healthcare and general practice, healthcare insurers have for a long time been procuring insufficient care or doing too little to make care accessible and/or future-proof. For example, there are more than 100,000 people on a waiting list for mental healthcare. Of these, more than 50,000 patients (57%) have been on a waiting list for longer than the Treeknorm (standard waiting time). According to the Court of Audit and the NZa, there are also an increasing number of people in the Netherlands who do not have access to a (regular) GP and/or are unable to obtain one.
On behalf of DBH and the 71 individual GPs, an enforcement request was submitted to the NZa in April 2024 to immediately proceed with sufficiently effective and concrete enforcement of the care (procurement) obligation for all insurers. This request was rejected by the NZa on the grounds that the GPs were not admissible.
The GPs then lodged an objection. In its decision on the objection, the NZa declared the GPs admissible, but nevertheless rejected the enforcement request again. The GPs then initiated appeal proceedings before the CBb. Maverick Advocaten is assisting GPs in various proceedings to improve the legal position of all GPs.
This includes obtaining realistic rates from the NZa (see here). But also adequate (enforcement of) binding NZa rules for healthcare insurers in healthcare procurement and tackling abuses of procurement power by healthcare insurers (see here and here).
For more information about the healthcare (procurement) obligation and its enforcement, see this opinion piece in Zorgvisie and this blog. For more information about the rights of healthcare providers in healthcare procurement and the options available to their trade associations to support them in this regard, see www.zorgcontractering.com.
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