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Chapter 8 | The impact of the crisis on the health system and health in the Netherlands
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The tariffs are set by the Health Care Authority (Dutch Association for Health
Psychology, 2014). Specialist mental health care, which can be both inpatient
and outpatient, is paid according to a DBC system. Since 2014, patients no
longer have to pay any additional cost-sharing charges.
Other efficiency-improving initiatives, such as connecting information and
communication technology systems between hospitals and GPs, have been
continued and were not triggered by the crisis. Merger of hospitals, which had
been taking place since around the 1960s (Schäfer et al, 2010), was another
development that contributed to improving efficiency in the sector. 13 Changes
in the delivery of care that have taken place since 2008 contributed to hospital
mergers: insurers and professional associations have increasingly set rules for the
minimum number of treatments performed by health care personnel that are
necessary to ensure sufficient quality in performing these treatments. Complex
care is increasingly organized centrally in a few specialist centres.
Elimination of fraud
Since 2010, more attention has been paid to fighting fraud in the health care
sector. The need to contain costs because of the economic crisis probably increased
awareness of the existence of fraud in the sector, and increased attention to fraud is
relatively new in this sector. While previously the integrity of health professionals
had not been questioned (patients asked for permission by the health insurer
before seeking care and this was sometimes checked by a physician employed
by the health insurer), currently remuneration claims are subject to much more
scrutiny. The implementation of the new case-based payment systems may have
increased fraud in the sector as upcoding leads to higher payments. However, it
is not always clear how the procedures should be coded: the regulation of casebased
payment is in itself a source of much confusion. According to estimates,
the monetary value of fraud in health care (i.e. care that was never provided and
fraudulent reimbursement claims submitted by health care providers to health
insurers) is between €1 billion and €3 billion (Blokker & Rosenberg, 2013).
Exact figures are not available and, therefore, on the request of the Ministry of
Health, the Health Care Authority is currently (commencing 2014) conducting
research into the magnitude of the problem.
With the exception of initiatives to optimize logistics in the area of
pharmaceuticals (taking into account their expiry date) and medical equipment,
measures to limit fraud, inefficiencies and waste of resources quickly became
13 Motives for mergers included, among others, providers' strategic motives: a larger hospital has more possibilities to
invest in buildings or new medical technologies, and a merger might enable synergies by eliminating duplicate services;
larger hospitals also have more countervailing power against health insurers. Moreover, government policy promoted
mergers: the budgets of new large hospitals were higher than the sum of budgets of the smaller hospitals before the
mergers. Finally, the introduction of market mechanisms and the preceding discussions formed an argument for
hospitals to merge in the 1990s. The trend towards consolidation resulted in a reduction in the number of hospitals
from 172 in 1982 to 94 in 2005 (Schäfer et al., 2010).