Managing sensible care in the standard health insurance package has not delivered change

Netherlands Court of Audit:

Health care that does not have a demonstrable effect and is not medically necessary has still not been removed from the standard health insurance package even after 6 years of trying. The Sensible Care programme was introduced in 2013 by the Health Care Institute of the Netherlands on behalf of the Minister of Health, Welfare and Sport (VWS) in order to achieve this goal but it has delivered scant cost savings. The Health Care Institute had estimated a potential cost saving of €265 [G1] million, but the Netherlands Court of Audit puts the maximum amount at €82 million.

Rapport Zinnige zorg

The Court of Audit finds that the programme has not lived up to expectations. It therefore concludes: stop or take a fundamentally different approach. The current approach will not achieve the ambition of stopping patients receiving unnecessary or ineffective care. Only if a more concrete programme is set up and is rigorously managed by results – a reduction in inappropriate care – will the message get through to GPs’ surgeries and treatment rooms. It can then also help improve care quality and cost control.

A new programme has been launched alongside the Sensible Care programme. The Minister for Medical Care and the Health Care Institute have high expectations of the Care Evaluation and Appropriate Use programme. 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.

The Health Care Institute set up the Sensible Care programme on behalf of the Minister of VWS in 2013. 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. Studies indicate that about half of all diagnostic procedures and treatments in the specialised medical care sector fall into this category. The public have a right to expect that the obligatory health insurance premiums they pay for their standard health insurance packages will not be used to pay for ineffective or unnecessary care.

Little pressure for more appropriate care

The Health Care Institute is implementing the programme in cooperation with general practitioners, medical specialists, care insurers and patients. Reducing the provision of inappropriate but insured care would increase the efficiency of the standard insurance package. The Health Care Institute and the Minister of VWS initially had high expectations of the programme; the aim was to save €225 [G1] million a year as from 2017. But in 2015 the minister dropped this target soon after the programme’s launch. Since then, the parties working in the programme have been under no pressure to achieve real cost savings. Improvements have become increasingly discretionary and perfunctory. According to the Court of Audit, the Health Care Institute lacks a strategy to exercise its powers if the parties in the field fail to make improvements.

Little change in practice

The insights gained from the Sensible Care programme have resulted mainly in changes in medical guidelines and patient information. Proposed improvements have not been picked up in practice and significant financial savings have not been made. The support necessary to make significant improvements has often lacking, too. Real change in GP surgeries and hospitals has not been achieved.