Update 20 August 2018

It has been summer vacation here in the Netherlands and not much has been going on these last few weeks. In this latest update on private healthcare in the Netherlands we cover:

  • Dutch insurance company moves to system to base part of payments for treating depression based on results. Local providers are very unhappy and other insurance companies say that they have no plans for similar initiatives. Will this make the Dutch market more interesting for organizations with experience with similar payment systems from other countries?
  • In our snapshot we give an overview of Zuster in de Buurt, a franchise organization providing home care.

Menzis will base part of payments for the treatment of depression on achieved results

Dutch healthcare insurance companies already make several payments to hospitals based on quality and results (hip replacements, etc.). For the first time a major Dutch healthcare insurance company (Menzis) has agreed with 18 mental healthcare organizations to make part of the payments related to the treatment of non-chronic depression dependent on quality criteria. The main criteria to be used will be Routine Outcome Monitoring (ROM) where progress is measured by answers to questionnaires filled out by the patient.

The suggested approach has met with criticism from the sector: Key critical issues include:

  • Providers will have an incentive to choose patients with easier to treat issues
  • Differences in the results of treatments are not due to differences in quality but other (unknown) factors
  • ROM does not give a valid view of the quality of treatment
  • If it was possible to measure quality, we (psychiatrists and psychologists) would have already done so

I must admit that the issues raised sound very familiar to me from any benchmarking exercise I have helped carry out. The 18 organizations who have agreed to pilot the new approach with Menzis are positive and believe that the new payment model can have positive effects.

Snapshot of a Dutch private sector healthcare operator: Zuster in de Buurt

Zuster in de Buurt loosely translates to “Nurse in the Neighborhood” is a franchise organization offering different types of homecare through independent contractors. The company was set up by Paul Hager after he acquired a bankrupt home-care company in 2014 and decided to develop a new way of working within home-care.

The independent contractors working with Zuster in de Buurt typically do not have contracts with the health insurance companies. Due to this they are typically paid 75% of the standard fees paid by the insurance companies to home-care organizations with contracts. Zuster in de Buurt takes a franchise fee of 8% to cover costs related to administration, IT systems, and marketing.

Zuster in de Buurt has four employees and claims to have “hundreds” of independent contractors working for them all over the Netherlands. Zuster in de Buurt is one of the main supporters of a court case against one of the insurance companies that is making it more difficult for independent contractors to provide home-case services through changed payment terms and processes.