under which hospitals operations are reimbursed
The management of money between healthcare providers and health insurers with regard to patients in Amsterdam. Some operations are not reimbursed in one Amsterdam hospital, but are reimbursed in another. Those who are not paying attention must pay extra themselves. But the information is missing for a weighted choice.
A hip replacement in Amsterdam UMC? For someone with a Basic Budget Policy at Zilveren Kruis, this will be an additional payment. Patients are reimbursed 75 percent of the average contracted rate. Additional payments can be thousands of euros.
In the OLVG, BovenIJ van Amstelland (Amstelveen), the same operation is fully reimbursed by Zilveren Kruis. “For, among other things, emergency care, obstetric care, dental surgery or very specific treatments, our clients with a Basic Budget Policy can ultimately go to Amsterdam UMC for a full fee,” said a statement from Zilveren Kruis. The same applies to a referral from a medical specialist from another hospital.
Zilveren Kruis is Amsterdam’s largest health insurer: more than half of the city is insured with it. As with other health insurers, the contract negotiations between Zilveren Kruis and the Amsterdam care providers went smoothly. Health insurers want to keep premiums as low as possible, while healthcare providers want to be compensated for the shared and double wage and energy costs.
Issues
Based on research from Comparison site Independer At Zilveren Kruis, Amsterdammers have more freedom of choice in hospital care than, for example, Aevitae. For example, someone with the Aevitae Basic Insurance Natura Select not only has to pay extra for plannable operations in Amsterdam UMC, but also in the OLVG. This also applies to people with an ordinary Zekur policy, who have a relatively low coverage of fully insured care in Amsterdam. Careful consideration of your health insurance policy therefore offers more freedom of movement.
But the problem with this careful coordination is that many agreements between the insurers and the healthcare providers are currently still pending. In 2020, almost all agreements between large insurers such as Menzis, Zilveren Kruis and VGZ were completed on 1 January, but that is now completely different. For hospital care alone, VGZ was still negotiating more than 62 of the 108 agreements at a national level this week, Zilveren Kruis still has to make agreements with 19 locations and Menzis has 49.
While the negotiations are still ongoing, healthcare consumers are obliged to choose before 1 January each year. Health care consumers actually obtained at the time of the choice therefore do not have the necessary information for a well-considered judgement. While that sometimes involves thousands of tens of thousands of euros. Not purchasing health insurance is not an option; such insurance is compulsory immersion.
Burger victim
“Now that more and more contract agreements have continued after the switch date of 1 January, the attention of healthcare consumers is turning more to insurers,” says health economist Wim Groot (Maastricht University). “Delay is part of the bargaining game between healthcare providers and insurers.”
Health economist Xander Koolman (VU University Amsterdam) argues that the healthcare consumer – that is, the citizen – is the victim. He therefore pleads in the television program On 1 for a stricter role of the government.
“This situation should not be allowed to continue,” said Koolman on Thursday evening. “The Dutch Healthcare Authority, as an executive body, must ensure that citizens are not left to fend for themselves.” In a more consumer-friendly scenario, all relevant information about reimbursements in the healthcare package is known one month before 1 January.