A recent bill presented by Minister Ernst Kuipers of Health, Welfare and Sport (VWS) aims to further restrict insured people's free choice of healthcare providers. Policyholders will only see their care fully covered if they turn to contracted healthcare providers; they will have to pay (in part) for the services of non-contracted providers themselves. Andre den Exter, Associate Professor of Health Law at Erasmus School of Law, views this proposal as a positive development for the Dutch health care system. He speaks out about it in the Financieele Dagblad.
The bill envisages that policy holders will only be able to visit care providers contracted by their health insurance company. Only partial reimbursement will henceforth be available for non-contracted care. The bill particularly affects the insured with an natura policy. This policy variant implies that health insurers select healthcare providers for their insured on the basis of various criteria, including price and quality. This system allows health insurers to purchase good quality care at lower costs. Therefore, with the help of the bill, Den Exter states, health care costs can be controlled and the insured will be given a nudge towards health care providers who offer good quality at reasonable costs.
What about the "right" to free physician choice?
Opponents of the bill argue that it limits insureds' freedom of choice and that the proposal violates the right to free physician choice. According to Den Exter, however, it is a misconception to speak of a "right" to free choice of physicians: "After all, that 'right' is forfeited with the choice of a natura polis. On the other hand, the insured does have a right to reimbursement for care received. Normally this is full reimbursement, but in the case of non-contracted care, the health insurer applies a discount that the insured must pay himself. That discount is determined by the health insurer and is a source of conflict between parties that is often settled in court."
Balance between freedom of choice and solidarity
According to Den Exter, completely abolishing reimbursement of non-contracted care would therefore improve efficiency. Although he does not see the legislature doing this anytime soon, the legislation is now accommodating health insurers by allowing a generic 25% discount on non-contracted care. This discount meets the "hurdle" criterion that establishes that the discount should not prevent insureds from turning to non-contracted health care providers. "Should this path be pursued, health insurers will indeed have a great deal of freedom to apply a discount contribution which will benefit the governing function and solidarity. Solidarity in health care is thus limited to contracted care and there is nothing wrong with that," Den Exter concludes.
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Read the article in Het Financieele Dagblad (in Dutch)