On 27 July 2023, the Information Centre for Healthcare Fraud (IKZ) published an overview of reports on healthcare fraud. André den Exter, Associate Professor of Health Law at Erasmus School of Law, finds this picture shocking. It is time for more drastic measures, as he writes in an opinion article in Nederlands Dagblad. According to him, the system of personal budgets (pgb), where the insured person can spend their own healthcare funds and enjoy maximum treatment freedom, should be abolished. An exception should be made for pgb care within the family circle.
The figures from IKZ show a slight decrease in fraud reports compared to last year, yet “the social costs remain unacceptably high,” according to Den Exter. “It’s high time for drastic measures. One of them involves abolishing the personal budget system. This benefit offers maximum freedom of choice to insured individuals to purchase their care, often from independent care entrepreneurs. However, freedom of choice comes with a price, as the risk of excessive or unjustified billing and the leakage of public funds into the pockets of care entrepreneurs is simply too great.” Den Exter refers to care entrepreneurs who abuse healthcare funds as ‘healthcare cowboys’.
A bigger role for municipalities and insurers
Of all fraud reports, 33 per cent involve pgb care, but according to Den Exter, that percentage may be higher if the overall picture of fraud signals becomes more transparent. Therefore, according to the health law researcher, pgb care should be replaced by contracted care by health insurers and municipalities: “[such care provides] more guarantees in principle to keep healthcare cowboys out.”
However, there are also issues when municipalities distribute healthcare funds: “While health insurers focus on special oversight of compliance with care contracts, municipalities lack the expertise to assess the quality of purchased care and the backgrounds of care entrepreneurs. Stories are known of unregistered care providers and real estate entrepreneurs offering care activities through dubious constructions that municipalities have hardly any visibility on. Oversight and control of in-kind care must and can also be improved. Nevertheless, due to the susceptibility to fraud, pgb care should be abandoned.”
Pgb care provided by family members
There is a form of pgb care that does work and does not lead to large-scale fraud, according to Den Exter: “An exception concerns pgb care provided within the family circle. Undoubtedly, pgb offers significant advantages here, including the continuity of care provided by a familiar person instead of different care providers. This category is limited in size and excludes commercial care providers.”
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Click here for the entire opinion piece in Nederlands Dagblad (in Dutch).
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