Every year, thousands of women in the Netherlands are diagnosed with breast cancer. While mastectomy and initial breast reconstruction are typically covered, the same cannot be said for follow-up operations. The health insurance company makes case-by-case decisions behind closed doors. Martin Buijsen, Professor of Health Law at Erasmus School of Law, is firm in his stance to NOS: "I believe there is discrimination."
Buijsen argues that breast cancer patients are being treated unfairly compared to other cancer patients. "This could be justified if there are valid reasons explained", Buijsen explains. "Since that is not the case, I believe there is discrimination. I think these women should be helped."
Breast cancer
One in seven women in the Netherlands is diagnosed with breast cancer each year. One-third of these patients undergo a mastectomy of one or both breasts. Women with a genetic predisposition to breast cancer sometimes choose preventive mastectomies. Annually, 5.000 to 5.500 women opt for breast reconstruction using their own tissue or silicone implants.
Initial breast reconstruction is typically covered by insurance. However, follow-up surgeries due to pain, rotating prostheses, or noticeable contour abnormalities or dents are not covered. To qualify for reimbursement, specific criteria set by the health insurance company must be met. For example, they consider the location of a dent and its size. If a dent falls within the cleavage area, it may be eligible for reimbursement with a smaller diameter.
A matter of money and non-transparent choices
No other type of cancer has such criteria in place. In those cases, the plastic surgeon determines whether a follow-up operation is necessary. According to Buijsen, this is a financial issue. Breast cancer is the most common form of cancer, requiring the most reconstructions. "Given the numbers, they have found it necessary to standardise this", Buijsen explains. "This is called implicit rationing of healthcare; choices are made in a non-transparent manner."
It is unclear why some follow-up surgeries are less likely to be reimbursed than others. Buijsen explains: "Rules have been established here without motivation. Women miss out if their dents are not deep enough or in the wrong area." Legal experts, including Buijsen, believe that the outgoing Minister of Health, Welfare, and Sport, Ernst Kuipers, should reconsider the reimbursements.
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