Search

De Hoge Raad heeft in 2014 bepaald dat verzekerden recht hebben op een substantiële vergoeding van niet door de zorgverzekeraar gecontracteerde zorg. Het is echter onduidelijk hoe hoog deze vergoeding minimaal moet zijn. Deze onduidelijkheid zorgt voor onzekerheid bij zorgverzekeraars en verzekerden. Het wordt tijd dat de wetgever duidelijke regels maakt die zekerheid bieden over de vergoeding. IN HET KORT ● Rechters nemen beslissingen over de vergoeding van nietgecontracteerde zorg, terwijl de wetgever dit zou moeten doen. ● Een oplossing is om verzekerden niet meer dan een maximumbedrag per jaar aan niet-gecontracteerde zorg te laten betalen. ● Een maximumbedrag biedt duidelijkheid voor alle partijen en moet zorgaanbieders stimuleren om contracten af te sluiten.

The Dutch health system provides broad universal health care coverage and is based on the principles of regulated competition. According to the OECD (2022), it is one of the best health systems in the world with regard to access to health care, equity and clinical outcomes. However, as also concluded by the Netherlands Scientific Council for Government Policy (WRR, 2021), as with other health systems, it faces important sustainability and resilience challenges, some of which were exposed and exacerbated during the COVID-19 pandemic. This report provides a comprehensive overview of the Dutch health system’s key features across the seven domains of the PHSSR framework: health system governance, health system financing, workforce, medicines and technology, health service delivery, population health and environmental sustainability. For each of these domains, the aim of the report is to (1) produce a critical assessment of the country’s most salient strengths, weaknesses and threats regarding the sustainability and resilience of its health system and (2) derive recommendations for health care policy. In addition to the seven domains mentioned above, we present two case studies. The first focuses on the resilience of the Dutch health system to the financial shock caused by the COVID-19 pandemic. The second examines whether collaboration (aimed at reducing coordination problems and facilitating integrated health care) and competition are reconcilable in the Dutch health system.

Ondanks de uitdagingen die het gevolg zijn van de coronapandemie staan de goede prestaties van de Nederlandse gezondheidszorg buiten kijf. Met het oog op de toekomst zijn er echter ook zorgen. Onlangs concludeerde de WRR (2021) dat de grenzen van de financiële, personele en maatschappelijke houdbaarheid van de zorg in zicht komen. Het nieuwe kabinet van VVD, D66, CDA en ChristenUnie heeft deze boodschap ter harte genomen en kondigt “stevige keuzes” aan. Maar maakt het nieuwe kabinet-Rutte IV deze keuzes ook echt?

In 2015 werd een deel van de langdurige zorg gedecentraliseerd naar de gemeenten om beter passende zorg te bieden en de zorgkosten te verlagen. Een onbedoeld effect van deze decentralisatie was dat gemeenten een financiële prikkel kregen om zorg­kosten te verschuiven naar de Wet langdurige zorg. Als dit ook gebeurt, dan staat dat het halen van het oorspronkelijke doel in de weg.

Sinds 2015 wordt de ouderenzorg gefinancierd via drie systemen. Het overkoepelende doel is goede en toegankelijke ouderenzorg op de juiste plek en tegen de juiste prijs. Samenhangende financiële prikkels voor preventie en het inkopen op kwaliteit zijn hiervoor onontbeerlijk. Maar in de praktijk werken ze onvoldoende.

The provision and financing of affordable and high-quality long-term care (LTC) to a rapidly ageing population is a major challenge for many countries. This is particularly true for Japan, which is faced with the largest share of elderly people, and the Netherlands, which has the most comprehen-sive and expensive public LTC insurance scheme. This paper analyzes the challenges for a sustainable provision and financing of LTC in the Netherlands and discusses which strategies are employed to meet these challenges.

With aging populations, the role of private insurance in financing long-term care and longevity risks is likely to grow in developed countries. Nonetheless, the demand for long-term care insurance (LTCI) and life annuities (hereafter annuities) is very limited and lags behind economic projections. A recurrent explanation holds that adverse selection dampens insurance demand. Integrating these products in a life care annuity (LCA) may effectively mitigate such adverse selection. In this Netspar Survey Paper we first analyze which factors impact the demand for LTCI and annuities. Next, we discuss whether LCAs can indeed increase insurance uptake. To do so, we systematically review the large and growing body of theoretical and empirical literature that analyzes LTCI and annuity uptake. Our results show that similar factors hinder the uptake of both LTCI and annuities. Specifically, we find that uptake is lowered not only by adverse selection, but also by substitution, nonstandard preferences, and limited rationality. Moreover, these factors may also explain why uptake is concentrated among wealthier and subjectively healthier individuals. An integrated product – only focusing on solving adverse selection issues – is unlikely to solve other aspects that limit uptake. Particularly, our results show that uptake for integrated products will likely continue to be concentrated among wealthier and subjectively healthier individuals. However, when insurers are able to cater to country-specific demand-side traits of substitution and nonstandard preferences, this may well increase the uptake of both separate and integrated products. The fact that uptake of private insurance is unequally distributed has important consequences for policymakers. Insofar as low uptake reflects an active choice to substitute for private insurance or reflects a dislike of private insurance, it echoes individual preferences and requires no action. However, insofar as it reflects adverse selection or limited rationality, lower uptake is a product of underlying inequalities in health, longevity and financial literacy and may warrant policy interventions. If the goal is to increase insurance uptake in private insurance markets, policymakers and insurers could undertake several actions to create a more inclusive insurance market. First, individuals with low financial literacy should be empowered to make their own insurance decisions. This can be achieved not only by policies that increase financial literacy, to provide for a better understanding of LTCI and annuity products, but also by making insurance decisions easier to comprehend. Second, risk awareness increases insurance uptake; policymakers and insurers could thus focus on raising awareness of LTC and longevity risks. Particularly, governments should be clear as to the scope of social benefits and as to the contribution that is expected from citizens themselves. Third, since our results show that distrust of insurers additionally drives low uptake, regulation that protects insured persons by guaranteeing the payout of fair claims may help to increase uptake. Finally, evidence on the importance of perceptions, framing, and defaults suggests that these may provide effective means for increasing insurance uptake.

One of the reasons why regulators are hesitant about permitting price competition in healthcare markets is that it may damage quality when information is poor. Evidence on whether this fear is well-founded is scarce. We provide evidence using a reform that permitted Dutch health insurers and hospitals to freely negotiate prices for elective procedures. Unlike previous research that has relied on indicators of the quality of urgent treatments, we take advantage of the plausible absence of selection bias in our setting to identify the effect on quality of non-acute hip replacements. Using administrative data on all admissions to Dutch hospitals, we find no evidence that increased exposure to price competition reduces quality measured by readmission rates, despite the lack of publicly available information on this outcome. In fact, there is evidence of a temporary, positive impact on quality. Our estimated null effect over the full post-liberalization period is robust.

Het Financieele Dagblad

Zorgvisie