Update 15 November 2022

Here in the Netherlands the weather is a strange mixture of beautiful sunny days and days with non-stop rain and wind. However, temperatures are high and gas consumption is low. In this update we cover:

• Bergman Clinics signs another multi-year contract with an insurance company. Is this yet another sign of specialized clinics becoming an integral part of the Dutch healthcare sector?
• Clients for light homecare will pay an own contribution based on income. Is this a first step in limiting use of these services?
• Director of the NZA (Dutch Healthcare Authorities) claims that the sector needs total overhaul to meet ongoing challenges. Is her thinking in line with that of the government?

Bergman Clinics signs another multi-year contract with insurance company

Bergman Clinics is the leading chain of specialist clinics in the Netherlands and is also active in Germany and Scandinavia. In the Netherlands, all healthcare providers must get annual contracts with one or more healthcare insurance companies. There is a trend towards multi-year contracts as these have advantages for both parties (less time on negotiations, less admin, more certainty, etc.), but a multi-year contract is usually reserved for “serious” providers with a good relationship with the relevant insurance company. Various commercial healthcare operators have already entered into multi-year contracts with healthcare insurance companies (including Bergman Clinics).

A.S.R. is a large insurance company with many service lines including healthcare insurance with the brands a.s.r. and Ditzo. It is one of the smaller healthcare insurance companies with a total market share of 3.1% but has been growing its market share in the last few years. A.S.R. and Bergman Clinics recently announced that they have signed a multi-year contract for the period 2023-2025. The contract focuses on three themes. These are aligned with key themes in the newly announced IZA program from the government (appropriate care, high quality care with a focus on the needs of the patient, and cost efficiency).

As explained in the previous update the specialty clinics are becoming an integral part of the overall Dutch healthcare sector. Commercial specialty clinics chains getting multi-year contract even with the smaller insurance companies is yet another sign of the growing importance of these operators.

Light homecare clients will have to pay an own contribution based on income

In the update of 17 November 2021 we describe how the demand for light homecare / social support has grown strongly due to demographics and the decision to limit the own contribution for these services to a standard €19/month. Several municipalities wanted to change this in order to reduce demand from “well-off” clients who could afford to pay for their own cleaning services. One year ago, it was not possible to change the system, but the government has recently announced that from 2025 the own contribution for these services will depend on income.

A household with an annual income of €30.000 (lower than the Dutch median household income) will then pay €6,70 more per month. The maximum own contribution will be €255/month for households with an annual income higher than €60.000. The expectation is that this will increase the attractiveness for richer household to pay directly for housecleaning services. This will reduce demand for the services from the municipalities and decrease their costs.

Director of the NZA wants dramatic changes to the overall structure of the Dutch healthcare sector

The NZA (Dutch Healthcare Authorities) has a broad range of responsibilities in the Dutch healthcare sector. These include:

• Defining the coverage of the compulsory healthcare insurance package
• Controlling that healthcare insurance companies purchase enough healthcare to cover the needs of their clients
• Setting maximum tariffs for key healthcare activities (this provides the starting point for negotiations between operators and insurance companies)
• Granting permission for acquisitions and mergers in the healthcare sector
• Providing the government with relevant advice

The Director of the NZA for the last eight years (Marian Kaljouw) is retiring and has given an interview in which she gives her viewpoints on what needs to change in the Dutch healthcare sector. Her main points are to a large extent in line with ongoing government programs such as IZA and WOZO. Her main point is that already now patients are often not receiving the care they need in a timely manner. An example is that patients sometimes must wait for three weeks to get an appointment with their GP. She believes that it will not be possible to provide all care in the manner that it is provided today, and that the government will need to make difficult choices regarding the types of care to be provided soon. Her key points are:

• Patients will need to take more responsibility for their own health and carry out (parts of) healthcare-related activities themselves or with help from family and friends
• Emergency care locations with low volumes should be closed and activities moved from hospitals to organizations / locations closer to the patient
• Insurance companies should be allowed to only pay for care provided by contracted operators
• Etc.

As explained in the update of 19 October the government is in a process of floating a number of fairly radical ideas for reducing the overall costs for healthcare. It can appear that the statement by the Director of the NZA is part of this process. The process is clearly needed but the path moving forward will be difficult. As an example, last week there was an animated debate in Parliament on the government goals of clustering emergency care. Many political parties are against this as they believe (correctly) that it will lead to less regional hospitals. To be updated.