“Financial considerations hinder freedom of choice in healthcare”

Buijsen describes the NZa's warning as justified. "Health insurers can be expected to be clear about reimbursements when in-kind policyholders want to purchase expensive care from non-contracted healthcare providers." However, the professor does argue that it is difficult for insurers to provide precise information. "The NZa rules are abstract and offer little guidance. This makes it difficult to give insured persons concrete and complete information."

Free choice of doctors under pressure

Health insurers are obliged to reimburse a reasonable percentage of the costs if insured people choose a non-contracted healthcare provider. But according to Buijsen, this varies significantly from one situation to another. "It makes quite a difference whether you have to pay 25% of the cost of a one-off prescription medicine dispensed by the pharmacist out of your own pocket or whether you have to bear the same percentage of a weeks-long stay in a mental health clinic", Buijsen explains.

These differences put pressure on policyholders' freedom of choice. Buijsen believes that, as a result, patients often still choose a contracted healthcare provider. "It remains guesswork, as there are no hard figures. But it is quite conceivable that, especially for more expensive treatments, patients are guided by cost considerations."

Reprimand as signal

That the NZa is taking formal action this time is remarkable. "It is unusual for the NZa to issue such a formal reprimand", Buijsen said. "They usually opt for informal discussions with insurers." Yet he signals a broader trend: "Waiting times, especially in mental health care, are now unacceptably long. The NZa seems to be taking a sharper line against health insurers."

According to Buijsen, the question remains to what extent this formal warning will lead to structural improvements. "Health insurers are now forced to come up with more precise rules and procedures after all. To what extent they succeed in doing so remains to be seen."

Criticism of NZa and importance of health insurers

Foundation Enforcing Free Choice of Doctors thinks the NZa does not go far enough. The foundation wants the regulator to set explicit limits on the cost of non-contracted care. Buijsen comments on their role. "The foundation does not represent the interests of patients, but those of non-contracted healthcare providers." He argues that health insurers often have good reasons for not signing contracts with certain healthcare providers. "Sometimes the quality of care is substandard or the rates are simply too high." Finally, Buijsen points out another important risk: "Non-contracted care turns out to be more susceptible to fraud in practice."

Abolition of the reimbursement policy?

The debate on free choice of doctors is further inflamed by the abolition of the reimbursement policy. With this policy, policyholders received full reimbursement, including from non-contracted healthcare providers. Buijsen nuances this picture. "That policy has not been legally abolished. Health insurers simply decided to stop offering it because it was not financially profitable." What remains are the in-kind policy and the combination policy. 

Solutions to the future

Buijsen stresses that health insurers will always discourage policyholders from choosing non-contracted care. "That is structural. But this does not alter the fact that they can and should be clearer in their provision of information to (prospective) insureds."

With increasing pressure on the healthcare sector, the debate on free choice of doctors does not seem settled for now. The NZa is taking a first step by formally addressing health insurers, but the future will show whether this is enough to actually guarantee the right to free choice of doctors. "Let's just see how the health insurers implement the NZa enforcement decision."