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Reimbursement mapping: THE NETHERLANDS. 2011. Content. Key Economic Indicators Healthcare Overview Reimbursement Systems Market Access Funding Mechanisms HTA Decision makers, Acronyms and Links Austerity Measures 2011. Key Economic Indicators the Netherlands.
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Content • Key Economic Indicators • Healthcare Overview • Reimbursement Systems • Market Access • Funding Mechanisms • HTA • Decision makers, Acronyms and Links • Austerity Measures 2011
Healthcare system overview • In the Netherlands the Ministry of health defines the general health policy and is responsible for regulations on health and healthcare planning. The duty of the provinces and of the municipalities is to assess the needs of the population. • 88% of establishments are private not-for-profit hospitals while almost all of the rest are public university hospitals. Commercial private hospitals, which have been long prohibited by the 1971 law on hospitals facilities, have recently seen their numbers grow but most are small structures.
Reimbursement system 1/2 • For the reimbursement of new medical devices the following criteria should be achieved: necessity of the treatment, cost, effectiveness and enforceability (within or by the healthcare system). • The process to create a new DRG code starts with a dossier mostly composed by the scientific association of medical specialist. The dossier should be handed over to DBC Maintenance. Then NZa and CVZ will be involved. • A special settlement for promising innovative medical products, to speed up the access to innovation, within the national health care system, is under construction. Besides that, each hospital has at its own disposal a local production-bound component (3-5% of the budget) to freely purchase innovative products. Academic hospitals have the so called academic component that is used with the same function.
Reimbursement 2/2 • In case a medical device has an additional clinical benefit but is not affordable it would not be approved, because of its unacceptable budgetary implications. The consequence is that the medical device would not be reimbursed and so it would not be available for most of the Dutch patients. • In this case, the medical device can be part of the so called orange DBC. Treatment is only possible after allowance of the health insurance company. It can be part of the supplementary package but not of the basic one. • In Holland it is possible to buy, when prescribed, non-reimbursed drugs as well as medical devices. Also medical devices can be bought without prescription. Non reimbursed treatments in hospitals are forbidden.entary package but not of the basic one.
Market Access • Taking into consideration the distribution channels for medical devices in community care settings the following three medical devices: incontinence materials, wound dressings and ostomy products are sold through pharmacies. Specialized medical devices shops have also a great part of the distribution. • Several wholesale organizations have their own chain of pharmacies like Mediq, Escura, Kring, Brocacef and Alliance. Mosadex is involved in direct sales to pharmacies. Finally there are sales targeted to hospitals and nursing homes. • Medical devices are sold in hospital settings through tenders organized by hospitals, through centralized procurement, considering that hospitals may join one or more procurement organizations and finally through individual contracts. • The academic hospitals launched at the beginning of this year a procurement initiative to increase centralization for the purchasing process.
Funding Mechanisms DRG system • Traditionally the Dutch government plays a major role in planning and regulating the health care sector. The Dutch Health care system is moving towards a more market-oriented and demand-driven approach and the central government is shifting responsibilities towards the health care providers and the health insurance organizations. • There is a uniform national application of the DRG-system in all the regions. The Ministry of Health, Welfare and Sports is accountable for the regulation on DRG-financing. • Hospitals have their costs reimbursed by the highly regulated function-oriented budgeting system, which is essentially a system of supply regulation and external budgeting.
Funding Mechanisms Other Funding Systems • The DBC-system is only used for acute care hospitals. DBCs include inpatient and outpatient care to medical specialists and rehabilitative care provided in hospitals as in specialized rehabilitation centers. • Medical devices in community care settings are funded through the Health Insurance Act or the Social Support Act, depending on the specific medical device taken into consideration. These funding mechanisms are the same in both primary care and home care settings. • Medical devices in hospital care are funded according to the Health Insurance Act. Medical devices have to fit in the DBC/ Care products and meet the criteria of state of science and practice (evidence based medicines). For new DBC’s the DBC Maintenance Organization, Dutch Tariff Board (NZa) and Health insurance Board (CVZ) play a separate role.
HTA • The use of cost-effectiveness data for both pharmaceutical and medical device products has been officially implemented since January 2005, leading to official requirements for submission of health economic reports comparable with the UK, Australia and Canada. • At the same time the BKZ, the annual maximum budget for healthcare, is crucial in the evaluation process. This applies for all kinds of care and so also for medical devices.
