Diederik Schrijvershof and Shannon Möller submitted an enforcement request to the Dutch Healthcare Authority (“NZa”) on behalf of NVOS-Orthobanda (“NVOS”). This request explains that health insurer Caresq has committed a number of violations of both the Healthcare Procurement Transparency Regulation Zvw (“Healthcare Procurement Regulation”) and the guidelines set out in the Guidelines for Contracting and Transparency of Contracted Healthcare (“Guidelines for Contracting”). The violations are detrimental to NVOS members. Caresq has failed to provide sufficient justification for its contract offer for 2026. This is in violation of Article 6.3 of the Healthcare Procurement Regulations. For example, Caresq has not specified which indexation has been applied for wage and price adjustments for 2026. It is also unclear how Caresq has incorporated the government contribution to labour cost developments (‘OVA’) into its rates. In addition, there has been a violation of Article 8 of the Healthcare Procurement Regulation. Caresq failed to communicate important changes to the 2026 healthcare purchasing policy to healthcare providers of orthopaedic aids in a timely, clear and complete manner.
NZa Healthcare Procurement Regulation
For primary care providers in particular, it is very important in practice that the health insurer provides timely and sufficiently clear reasons for whether and why a contract offer includes indexation and/or markdowns in the pricing. This follows not only from the above-mentioned NZa regulations. It also follows from established case law. For example, the STAR ruling states that healthcare purchasers must always take into account the legitimate interests of healthcare providers and, in that context, may not systematically refuse to index contracts. Read more about the STAR ruling here. The NZa has previously made it clear (as here and here) that it will take stricter action against (persistent) violations of the Healthcare Procurement Regulations. The importance of sufficient transparency during the contracting process is also emphasised in the guidelines of the NZa's Contracting Guidelines.
The NZa has previously imposed formal warnings on several health insurers for violating the Healthcare Procurement Regulations. For example, the NZa recently warned VGZ and earlier Zorg en Zekerheid, CZ, Zilveren Kruis, Menzis, EUCARE and DSW for violations of the Healthcare Procurement Regulations. VGZ and Zilveren Kruis were also previously fined by the NZa for violations of the Regulation.
Maverick Advocaten has been committed for years to ensuring adequate (enforcement of) binding rules for health insurers in healthcare procurement and tackling the excesses of health insurers' purchasing power. For more information, see here, here, here, here and here. For more information on the rights of healthcare providers and the obligations of health insurers, please visit zorgcontractering.com. And see this (video) briefing to find out why, based on the STAR ruling, healthcare purchasers are required to take the increased costs for healthcare providers into account in their healthcare procurement.
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