Fewer and fewer health insurance companies offer reimbursement. Such a policy allows customers to choose which healthcare provider they go to. The insurer covers the cost of care even if the provider does not have a contract with the insurer.
Three insurance companies, CZ, Zilveren Kruis and Stad Holland, will stop offering full reimbursements for care from some mental health and community health providers next year. Other insurers have already done this.
Higher rates without a contract
“Freelance nursing providers in community nursing and mental health services often charge more than the average market rate,” says CZ. “This increases everyone’s health insurance contribution. “Reimbursement policy needs to be replaced with combination policy to ensure healthcare remains affordable and accessible.” This year at CZ, only 5 percent of customers have a refund policy.
“In community nursing, we see non-contracted individuals providing more care per patient. If a contracted person can help people well even with fewer hours, it would be better for the premium payers,” a spokesperson for Zilveren Kruis said about the decision.
Mental health care: reduce waiting lists
In the field of mental health care, Zilveren Kruis notes that new providers are focusing primarily on people with milder mental health conditions, while waiting lists for more serious mental health care continue to grow. “We believe that by stopping reimbursement for everything and also rewarding serious mental health providers, we can make progress in reducing wait lists,” the spokesperson said.
This year, Zilveren Kruis has contracts with 87 percent of psychiatric care providers and 92 percent of community health services. For contracted providers, everything will continue to be reimbursed next year; For providers without a contract, 85 percent of the average fee will be refunded.
“Problems may increase
Psychologist Chiara Staal of Cohen Psychologists in Amsterdam is concerned about the disappearance of the refund policy. “People who are currently receiving treatment may no longer receive fees from their psychologists. They will then have to break the relationship of trust they have built over the years. You will need to find a new practitioner and may need to seek treatment again. There are countless waiting times and your problems may increase.”
Marco Varkevisser, professor of health market regulation at Erasmus University, believes that the disappearance of reimbursement policies is not a surprising development. “Insurers face high payments to uncontracted healthcare providers. “So tightening the reins is a logical step for them.”
“And to put it into perspective: Only 5 percent of insureds have such a reimbursement policy.” He also does not believe that the freedom to choose a doctor is in danger. “Insured people can still go to any doctor, but the full cost will no longer be reimbursed. No one forbids a patient to visit the doctor of his choice. “We should not act as if there is no freedom of choice when it comes to regular property insurance.” . “There are many contracted healthcare providers.”
transitional arrangement
CZ, Zilveren Kruis and Stad Holland have made transition arrangements for 2024. For example, anyone who has a reimbursement policy this year and has already started treatment will continue to receive whatever is refunded. This will end in 2025.
There are only two insurance companies known to offer next year refund policies: Menzis and ASR. A third party, Aevitae, will announce whether the refund policy will be resumed by Sunday at the latest. Health comparison expert Zorgwijzer calculated that the number of reimbursement policies has been decreasing for years. There were 21 in 2019, 11 last year, 6 this year and only 2 or 3 next year.
15 euro difference
The price difference between a policy with freedom of choice and one without is significant. For example, in Menzis it is 15 euros per month (161.75 versus 146.75).
This morning it was revealed that basic premiums for the four major insurance companies will rise by between €5 and €8.50 next year. This is below the 12 euros the cabinet had expected.
Source: NOS
Roy Brown is a renowned economist and author at The Nation View. He has a deep understanding of the global economy and its intricacies. He writes about a wide range of economic topics, including monetary policy, fiscal policy, international trade, and labor markets.
