General practitioners in the Netherlands are planning to strike on Wednesday, June 4, in order to make their patients aware that adjustments to the Health Insurance Act currently being mooted will prevent them from choosing their own medical specialist.
Currently in the Dutch health insurance system, insurers are required to pay a certain amount to patients who go to a specialist or facility that is not partnered with the insurance company, offsetting at least part of the cost of treatment for the patient.
If the amendment to Article 13 of the Health Insurance Act passes in Parliament, however, that obligation to pay even part of the cost will be scrapped, and insurers will only cover the costs of those patients who go to practitioners with whom they have a contract.
Not all GPs are planning to strike for one hour on Wednesday, only the ones from industry group Vereniging Praktijkhoudende Huisartsen (VPH), which has about 700 members.
The much larger National Association of General Practitioners (LHV) will not be participating. A spokeswoman for the LHV said that while they too were against the proposed amendment, but think that a strike is not in the interests of the patients.
Herman Suichies, a spokesman for VPH, said that they were protesting because they consider patients being able to choose their own practitioner a fundamental civil right, one that would be utterly undermined by forcing patients to only go to providers selected by their insurer.
They are also encouraging other medical practitioners including dentists, physiotherapists, psychologists and pharmacists to also stop work temporarily to protest against the amendment.
Specialists such as physiotherapists have already been put under pressure to lower their fees by insurance companies. Now, the amendment could allow insurers to refusing to offer contracts to specialists if they find their fees too expensive or even if they think there are too many in one area.
Proponents of the amendment, including the Nederlandse Zorgautoriteit (Dutch Healthcare Authority) and the Minister of Health, say that this will make care cheaper and stop insurance premiums from rising so quickly.
Changes that have already been made to health insurance have resulted in the new cheaper insurance policies carrying a risk of patients not being fully covered for surgery.
Some inexpensive policies only offer full coverage at Dutch hospitals with which the insurer has an arrangement; if patients go to a hospital that is not partnered with their insurer, they can be liable for up to 50 per cent of the costs.
Now, should the amendment go through, if patients choose a practitioner who does not have an arrangement with their insurer, they will not be reimbursed at all.
"If we refer a patient to a specialist because we find he is good at his job, then we must first check whether our patient may go to him because of his insurance," said Suichies.
Moreover, the insurers' selection of practitioners and facilities, he argued, is primarily based on cost and profit margins. "The power of the big four national health insurers, who have 90 per cent of the market, is already unacceptably large."
Another effect of letting insurers control who treats patients is to limit health sector innovation, argues Jan van Bodegom of Alexander Monro Borstkankerziekenhuis, a clinic specialising in breast cancer.
Open only a year, this clinic has been a success in treating patients, but if the amendment passes, Van Bodegom says it will be a disaster for innovation in healthcare.
"Insurers’ contracts are not purely based on quality; they also protect their vested interests. Soon there will be no initiative able to occur independently in an existing hospital," he said.
The government will debate the amendment in Parliament this Thursday, June 5.