Netherlands

The deadline for acceptance of applications for conditional reimbursement in 2020 was announced by the is Zorginstituut Nederland, which is 15th of May 2018.

The Dutch Healthcare Authority (Nederlandse Zorgautoriteit) has published a draft version of the DBC package for specialist medical care for 2019 (RZ19a).

The generic quality framework and three modules of care describe the general requirements for medical devices for home-based application, included in the Health Insurance Act (Zvw). This framework is not intended for medical devices that fall under the Social Support Act (Wmo) and medical aids provided in intramural settings.

The Dutch National Health Care Institute (Zorginstituut Nederland) published a position paper with results of 4-years observation of transluminal endoscopic step-up approach in patients with infected pancreatic necrosis. In accordance to this document the procedure fulfils the criteria ‘state of science and practice’. The method can be reimbursed within basic health insurance.

The changes of the DBC package for specialist medical care in 2019 (RZ19a) will include pediatric oncology, proton therapy, and telemedicine.

The Dutch National Health Care Institute considered that application of one-way endobronchial valves for endobronchial lung volume reduction fulfills the criteria of “state of science and practice” for patients with severe emphysema and insufficiency of drug treatment. Therefore, this procedure can be included into a basic package for appropriate indication.

In accordance with Health Insurance Act (Zvw) and Long-term Care Act (Wlz) the basic package of insured health care includes only health care that fulfills the criteria of “state of science and practice”. In September 2017, ZIN published opinion paper on the basis of reevaluation of the procedure. It was only recommended for coverage for non-resectable colorectal liver metastases. Other indications were not approved for coverage.

In the Netherlands, there is a possibility to test novel ways of delivering health care services (e.g. mobile diagnostic modules, online counselling, telemonitoring, screening/diagnostic for some complex conditions in primary care etc.) by establishing short (3 years) experiments between health provider and insurance company. After completion of experiment, analysis shall be performed about effect of the intervention. If it works, a new model can be population as novel type of care service in broader settings. See full list of ongoing small-scale experiment projects, extracted by MTRC.

Dutch National Health Care Institute (Zorginstituut Nederland) has confirmed scope of surveillance on implementation of radioembolization with Yttrium-90 microspheres as salvage therapy for patients with non-resectable liver metastases of colorectal cancer origin in the Netherlands. The focus will be on evolution of cost and volume of procedures, concentration of care in few designated centers and implementation of clinical protocol for use of procedure.

Dutch Health Care Authority (NZa) has been working on developing tariffs for diagnosis-related groups (DBCs) to reimburse special medical rehabilitation care (medisch-specialistische revalidatiezorg, msrz). Originally, it was planned to roll out new payment model (DRGs with national tariffs) in 2019, however, NZa decided that more time is needed to collect cost data to determine appropriate tariffs.

Researchers evaluated care process, access, administrative efficiency, equity and health care outcomes in 11 countries on the basis of published health care statistics for 72 indicators. The best overall performers among European countries were the UK (ranked 1st), the Netherlands (3rd), Norway (4th), Sweden and Switzerland (6th). Germany (8th) and France (10th) were low in the ranking.

The treatment with autologous fat transplantation (AFT) may be a part of the basic health insurance package under certain conditions, including defects of the head and / or neck region, HIV-associated lipoatrophy and, and fibrosis (scarring), as recommended by the Dutch Health Care Institute (Zorginstituut Nederland).