-
02 February 2024 | Country Update
Attempts to include dental care in the basic benefits package are unsuccessful yet again in the Netherlands
Future developments
Now that the key reforms since 2006 have significantly changed the organization of health care in the Netherlands, future health policy will be mainly directed towards fine-tuning and optimizing the reforms: the focus will remain on improving quality and containing costs.
In the Netherlands, dental care for adults is not part of the basic benefits package. In the past, several attempts have been made by parties in parliament to reintroduce it without success. A recent attempt was again rejected by the majority in parliament on 30 January 2024. This would have included all dental care in the package or only the yearly screening. The expectation is that it will return on the agenda when the new government is formally in place. The majority in parliament had included the inclusion of dental care in the basic package in their electoral programmes.
Authors
References
KNMT. Lower house rejects motions for oral care in basic insurance [Tweede Kamer verwerpt moties voor mondzorg in de basisverzekering]. 31 January 2024, accessed 1 February 2024. https://knmt.nl/nieuws/tweede-kamer-verwerpt-moties-voor-mondzorg-in-de-basisverzekering
Tweede Kamer. Motion by members Dijk and Ergin on the inclusion of oral care in the in the basic package [Motie van de leden Dijk en Ergin over mondzorg opnemen in het basispakket], #36410-XVI-73, 25 January 2024,accessed 1 February 2024, https://www.tweedekamer.nl/kamerstukken/detail?id=2024Z01158&did=2024D02675
Improving quality of care
The government has sought to improve care quality in various ways; initially, for example, by limiting the free choice of providers and giving insurers more tools to steer patients to selectively contracted providers (see section 3.3.4). This led to a great deal of protest and a change of plans that ensured a free choice of primary care provider. The changes necessitated an amendment of the health insurance act and were approved in parliament in June 2014. In December 2014 the changes failed to pass the Senate (National Association of GPs, 2015). In 2015 the Minister of Health gave up the idea to change the law, but decided to introduce measures within the limits of the existing law that promote quality of care and aim to direct patients to good quality health care providers. The plan is called “Quality pays off” (Kwaliteit loont).
The main aims of the “Quality pays off” measures are to strengthen the position of the elderly and chronically ill and to improve quality. The measures are:
- stimulating health insurers to give patients a reduction on the mandatory deductible if they visit contracted providers, a measure that had already proved successful in encouraging patients to use preferred medicines;
- amending the risk adjustment system in such a way that it becomes attractive for health insurers to sell health plans to chronically ill persons and provide them with high-quality care;
- not charging providers that have a contract based on quality and price for overspending, thus incentivizing these quality-based contracts;
- developing quality standards, especially for the mental health care sector;
- giving the insured more influence on the policy of their health insurers; and
- counteracting mergers that led to further consolidation among health care providers.
Most of these measures are planned to come into effect in 2016 (Ministry of Health, Welfare and Sport, 2015a).
Promotion of informed decision-making by patients
Transparency remains a key issue in the Dutch health care system, since citizens can only make informed decisions if they have access to clear and comprehensible information. Currently there are many different health plans, which are difficult to compare. The NZa plans to investigate whether this hampers the proper functioning of the market (Dutch Healthcare Authority, 2015b). In 2015 the Minister of Health agreed with Health Insurers Netherlands, the umbrella organization of the Dutch health insurers, to improve comparability of information for the insured population. Insurers should provide standardized information on the profit they make, the composition of the premium, whether financial reserves have been used to lower the premium, and the different conditions across offered health plans. In addition, they should clearly communicate that all citizens are accepted for the basic package. Furthermore, health insurers plan to make switching easier for persons who use medical devices or disposables by automatically adopting the authorizations of the former insurer. Lastly, health insurers decided to include care products (actual provided care) within the DBC on the patient’s bill (Ministry of Health, Welfare and Sport, 2015b).
The NZa is working on regulations that target clear communication on which care is subject to the mandatory deductible and on making transparent beforehand what will be the cost of treatment. Furthermore, the Authority is planning to bring in regulation of websites that compare health plans, to make the information more reliable and comparable. In the first years after the reform, a government-funded agency provided a website that compared health plans and providers, but more recently the site has only provided information on providers, since sufficient comparative information on health insurers was available on commercial websites. However, commercial sites differ in the way they select and present their data, resulting in different results for similar requests for comparison, and the selection criteria are not always clear.
Prevention of fraud
Prevention of fraud in the sense of illicit billing (such as upcoding or billing non-provided care) by health care providers is a continuous point of attention. A point of discussion is medical confidentiality: which data should be available to health insurers and payers of long-term care to be able to check the bill, and to what extent does that conflict with the interests of the patient, who may expect medical confidentiality from the health care provider.
Changes in long-term care
For the 2015 reform of long-term care it is too early to speculate whether the Acts will be adapted, and if so, whether the Acts will appear to be effective after a period of habituation.