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450 Economic crisis, health systems and health in Europe: country experience
More long-term care is now provided by ambulant home care and social
workers, or family caregivers. Those in need of long-term care were enabled
to “purchase” their care according to their specific demands, and as much as
possible through local providers. Since 2013, municipality employees in some
regions discuss health care needs and potential providers with people who need
long-term care, in order to customize care and save costs.
• Dietary advice was removed from the standard benefits package in 2011; in
2014, three hours of dietary advice was reincluded in the standard benefits
package following calls to reconsider this decision.
• Since 2011, dental care for persons between 18 and 21 years of age is no longer
reimbursed; dental care for persons aged 21 and older had been excluded since
2006.
• A proposal to restrict access to mental health care was dropped following
strong opposition (2012); coverage of in vitro fertilization and physiotherapy
was restricted (2013).
• Since 2008, several medicines, treatments and (walking) aids have been
removed from the standard benefits package. Examples of limitation of
coverage in medicines are sleeping pills (benzodiazepines), gastric acid
blockers, statins (lipid-lowering medication), contraceptive pills and
antidepressants. These medicines are only reimbursed in severe cases or
for long-term use.
User charges
• Increases in co-payments for some health services (physiotherapy and dietician
care) (2010).
• Increase in the annual deductible that all adult insured people have to pay
from €220 to €350 (2013).
• Introduction of a new co-insurance rate of 25% for hearing aids (2013).
• Co-insurance for psychology services abolished (2013).
Changes to health service planning, purchasing and delivery
Prices of medical goods
• Introduction of policies giving health insurers the lead in purchasing care
at competitive prices was accelerated (2010), for example health insurers
benchmark hospitals according to their expenses on medical goods and advise
them on cost-saving (e.g. through procurement by collective bargaining with
suppliers, procuring from countries such as China, and the use of (electronic)
auctioning). In 2013 an initiative was started to monitor surplus of medical