Diederik Schrijvershof was interviewed by a nationwide financial newspaper about the Dutch Healthcare Authority's (NZa) role in enforcing the statutory duty of care of healthcare insurers (Article 11 of the Health Insurance Act).
Although the NZa now wants to enforce the duty of care after years of rejecting calls to do so, Diederik Schrijvershof believes that the NZa's current approach further erodes the duty of care. For example, there are no clear consequences for health insurers that fail to fulfil their duty of care: "I notice at hearings that health insurers are not impressed. There are still no consequences for failing to fulfil the duty of care, I am absolutely convinced of that."
The NZa limits itself to issuing instructions to health insurers without disclosing their content. “They don't publish anything about what CZ should do exactly”, says Schrijvershof in the FD. “This lack of transparency makes it unclear what the duty of care entails according to the regulator. And what are they actually threatening to do if the health insurer fails to comply again? We don't know that either.”
“The situation is quite straightforward. Health insurers are not purchasing enough (even though the capacity is available), and/or their care coordination is inadequate or ineffective. Those on waiting lists are unaware that, in the latter case, they are entitled to full reimbursement of care from a care provider, even if their insurer does not have a contract with that provider. The NZa and the health insurers constantly play the game of saying that the duty of care is all very complicated, but that is nonsense. The NZa has failed to enforce the rules effectively for years, which is why insurers are not taking sufficient action.”
In addition, the ineffective enforcement of the NZa (in)directly leads to an increase in demand for care. For example, general practitioners are often unable to refer patients with serious mental health problems, which causes their symptoms to worsen and leads to people dropping out of work. In this context, timely referral is essential for limiting the demand for care: “If you refer people in time, more care will be needed in the short term. But in the long term, it actually saves money. Moreover, these insured persons have paid premiums for that care and are therefore entitled to it.” Read the full FD article here.
Earlier this year, Diederik Schrijvershof and Leah Peeters wrote an opinion article about the enforcement of the duty of care by the NZa in Zorgvisie. They also blogged about the lack of effective enforcement by the NZa. Maverick Advocaten has been campaigning for years for effective enforcement of the duty of care by the NZa, see here, here and here. In addition, Diederik Schrijvershof and Annabel Kingma, on behalf of Stichting De Bevlogen Huisartsen (Foundation the Passionate General Practitioners) and 71 individual general practitioners, submitted an enforcement request to the NZa regarding the duty of care of all healthcare insurance companies. For more information, see www.zorgcontractering.com.
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