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Free Choice of Doctor

Vrije Artsenkeuze
Netherlands-Flag-icon Germany-Flag-icon In the Netherlands, free choice of doctor is laid down by law. Due to the small proportion that some health insurers reimburse when a service provider does not have contracts with the health insurers, this can be seen as a limitation of the statutory entitlement. The Stichting Handhaving Vrije Artsenkeuze (Stichting VA) filed a case in this matter. In the meantime, the competent court has pronounced its verdict, which can be read here in the (Dutch) original. Also interesting is a blog post of the lawyer who was representing Stichting VA.

Below, you find an article which was originally published on the website of Stichting Handhaving Vrije Artsenkeuze (Stichting VA) and which we had translated by www.DeepL.com/Translator:

Background


Health insurers conclude contracts with care providers for the provision of care. Every patient/insured individual has the statutory right to choose whether to go to a healthcare provider contracted by his healthcare insurer (hereinafter: the contracted healthcare provider) or to a healthcare insurer that does not have a contract with the healthcare insurer (hereinafter: the non-contracted healthcare provider). This right is laid down in Article 13 of the Healthcare Insurance Act. If a patient turns to a non-contracted healthcare provider, he or, in his place, the healthcare provider, receives reimbursement from the health care insurer.

There has been discussion in the field for years about the question of how much the minimum reimbursement a patient should receive if he turns to a non-contracted care provider. This question has in the past - in the context of summary proceedings - been referred to the Supreme Court. The judgment of the Supreme Court of 11 July 2014 brought the discussion to a provisional end. Since then, the provisional practical rule has been that a healthcare insurer is obliged to pay at least 75% of the market-conforming rate when a patient goes to a non-contracted healthcare provider. It is assumed that a reimbursement that is lower than 75% of the average contracted rate will be in any case lead to an obstacle. The proceedings of which the judgment of the Supreme Court formed the final part were preliminary relief proceedings, which were a preliminary ruling by the Supreme Court on the question of what the applicable law is and how it should be interpreted.

The proceedings


The VA Foundation has established that health insurers still have a policy that unacceptably hinders access to non-contracted care providers. With this procedure the VA Foundation first of all wants to put an end to the practice of applying a reimbursement percentage of 75% to all forms of non-contracted care and thus applying a generic discount of no less than 25%. According to the VA Foundation, applying such a standard discount is in many cases contrary to Article 13 of the Healthcare Insurance Act.

Furthermore, VA is of the opinion that health insurers incorrectly deduct the discount from the 'average contracted rate' instead of from a rate in line with the market. Such an application not only leads to a lack of transparency (the rates used cannot be checked for correctness), but also to unrealistic rates. In practice, an 'average contracted' rate says nothing about the actual price for treatment and therefore about what should be regarded as the rate in line with the market. This is partly due to the fact that health insurers do not make agreements with hospitals per treatment, but for the total amount of treatments, and that hospitals then (partly) determine the prices of treatments themselves (of course in consultation with the health insurer, but without the actual price of a product playing a role in this). This has been the subject of much media attention in recent years. The result of the policy of the health insurers is that care providers are forced to work below cost price.

The VA Foundation has involved two health insurers, VGZ and Menzis, in a procedure, but notes that almost all health insurers act as VGZ and Menzis do. Because this is a test case, the VA Foundation has chosen not to sue all health insurers. CZ and Zilveren Kruis have joined Menzis and VGZ, so the procedure will now involve four health insurers.

The VA Foundation has brought the proceedings before the District Court of Gelderland.

CZ and Zilveren Kruis join VGZ and Menzis


After the publication of our summons to Menzis and VGZ, Zilveren Kruis and CZ joined the proceedings. The great general interest of our demands is for ZK and CZ the argument to ask the court of Gelderland to join. This request has been granted. On balance, this means that the proceedings on the merits will be brought against the four major health insurers.


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