Insured for Sensible Care

The Sensible Care programme’s contribution to the appropriate use of the standard health insurance package 2014-2019

The Health Care Institute of the Netherlands introduced the Sensible Care programme on behalf of the Minister of Health, Welfare and Sport (VWS) in 2013. Together with general practitioners, medical specialists, care insurers and patients, it identified diagnostic tests, treatments and operative interventions that were covered by the standard health insurance package but had no demonstrable effect or clear added value for patients. Reducing this inappropriate use of insured care would increase the efficiency of the standard insurance package. It would also cut costs.

Why did we audit the results of the Sensible Care programme?

The continuous increase in health care expenditure is fuelling social and political discussion of the care that should or should not be paid for collectively by means of standard health insurance packages. Studies indicate that about half of the diagnostic procedures and treatments in the specialised medical sector have no proven effect or added value for patients but are nonetheless covered by the standard insurance package. The public have a right to expect that the obligatory insurance premiums they pay for their standard insurance packages will not be used to pay for ineffective or unnecessary care. Reducing such inappropriate care would be a significant driver to control collective health care expenditure. 

What are our main conclusions?

The audit found that the Sensible Care programme had not lived up to expectations or helped to contain health care expenditure. The Court of Audit therefore concludes: stop or take a fundamentally different approach. The current approach will not achieve the ambition of stopping patients receiving unnecessary or ineffective treatments.

A new programme was recently launched alongside the Sensible Care programme. The Minister for Medical Care and the Health Care Institute have high expectations of it. But the Court of Audit notes that the two programmes are very similar to each other and suspects the new programme will run into the same problems

What are our recommendations?

he Court of Audit recommends that the programme be made more concrete and managed more rigorously in order to reduce the provision of inappropriate care. Only then can the results lead to real changes in GPs’ surgeries and hospitals and contribute to care quality and cost control.