Advice on criteria for inclusion of technologies into the basic health insurance in the Netherlands

On May 21, 2025, the Dutch Healthcare Institute (ZIN) published the Advice on considering staff deployment and sustainability criteria when assessing whether to reimburse medical procedures and technologies from basic health insurance. The publication contains clear calculation methods for both subjects and Advice on using them in evaluating medical technologies.

The committee's Advice outlines methods to quantify differences in labor input and environmental impact between two interventions and illustrates how these factors influence scarcity. Additionally, the committee recommends deliberatively weighing these outcomes alongside other relevant criteria, which ZIN typically uses to determine if care qualifies for reimbursement under basic health insurance: effectiveness, cost-effectiveness, necessity, and feasibility.

The following parameters are proposed by the committee to calculate the impact of the labor input: 

• Incremental labor input: the difference in labor input required per patient to implement the intervention, compared to the current care;
• Total labor input impact: the difference in labor input required to treat all patients eligible for the new intervention compared to current care.

The committee operationalizes sustainability as (the lowest possible) environmental impact and then focuses on climate impact, measured as the emission of CO2 equivalents, with the calculation of the following parameters:

• Incremental climate effect: the difference in greenhouse gas emissions (in CO2 equivalents) required per patient to implement the intervention, compared to current care;
• Total climate impact: difference in greenhouse gas emissions (in CO2 equivalents) needed to treat all patients eligible for the new intervention, compared to current care.

From May 2025, ZIN started a three-year trial period to consider the staff shortage in healthcare and the consequences for the planet in their decisions. ZIN also conducts trial assessments to gain experience calculating and weighing these new topics. After 1.5 years of trial, ZIN will provide an evaluation based on the experience gained with case studies. The results of this evaluation will be discussed with the Ministry of Health, Welfare, and Sport.

See more information in Dutch here.

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