The Dutch Healthcare Authority (NZa) recently imposed a formal directive on two major health insurers, CZ and Menzis, for failing to fulfil their duty of care. This drastic measure highlights the seriousness of the situation around healthcare access in the Netherlands. Martin Buijsen, Professor of Health Law at Erasmus School of Law, was quoted on the directive in Het Financieele Dagblad: "The accessibility of care did not really have the attention".
Buijsen clarifies that the specific problem that led to CZ and Menzis's directives is waiting times. Health insurers are responsible for procuring sufficient care so that their policyholders can receive the necessary treatments in a timely manner. "Care is sufficiently procured when the natural policyholders insured with those health insurers do not have to wait too long for the care they need, the care that is appropriate for them. If it concerns policyholders with a restitution policy, the healthcare insurers fulfil their duty of care when they mediate sufficiently well to the healthcare providers who can provide suitable care for them. The NZA has found that policyholders at CZ and Menzis have to wait too long for suitable care", Buijsen explains.
Waiting times and duty of care
Whether the duty of care is met is a complex issue. Buijsen explains that the NZA uses several criteria to measure the performance of health insurers. "Different aspects of the duty of care are measured differently. If we specifically talk about waiting times (length of waiting lists), they must be within the so-called Treek norms." Buijsen explains that for each form of care, health insurers and healthcare providers once agreed on the acceptable waiting time. Buijsen: "After all, a waiting list should not be so long that additional health damage is caused by the time spent while waiting."
NZa has been investigating health insurers' compliance with the duty of care since 2017. Why did it take so long before formal action was taken? Buijsen explains that the focus has shifted within the healthcare sector: "The main reason is that the main focus in recent years has been on the affordability and quality of care. The accessibility of care was not really the focus." According to Buijsen, that has changed because accessibility has been compromised by staff shortages in healthcare and increased demand for care.
Buijsen explains that the shortages were due to scarcity in the labour market and relatively high absenteeism in the healthcare sector, which was caused mainly by an aging population. "Things are really starting to fray in healthcare now, and that signal in particular seems to emanate from the measures imposed by the NZa."
"Do not just look at the premium"
Regarding the role of healthcare providers, politicians and policyholders in improving healthcare access, Buijsen stresses the need for more cooperation between parties. "The idea that healthcare providers should compete with each other in the healthcare procurement market and try to favour the healthcare insurer as much as possible will have to be abandoned. There will have to be much more cooperation between healthcare providers. And politicians will have to come up with measures to facilitate this." He also advises policyholders not to look only at the premium when choosing a health insurer: "The individual insured would do well to look not only at the level of the nominal premium when making his or her choice of a health insurer, but also at the insurer's performance where waiting times are concerned."
Buijsen warns that such imposed measures are damaging the image of CZ and Menzis: "Of course, it is not a good advertisement. However, the choice of health insurance and a health insurer is not made by policyholders until the turn of the year. That is still a while away."
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Read the entire article of Het Financieele Dablad here (in Dutch).