Medical specialist care purchasing

Medical specialist care is care such as medical specialists generally provide. Hospital care is a broad concept. It includes all institutions appropriately admitted by the Ministry for Health, Welfare and Sport. They are general hospitals, university hospitals, independent treatment centres, rehabilitation centres and radiotherapy centres (radiation).

1. Vision on healthcare

1.1 Why do we enter into contracts?

HollandZorg wishes to purchase quality, affordable and accessible medical specialist care. Accessible relates to issues such as waiting times for treatment or travel distance, for example. So far, we have been concluding contracts with all Dutch hospitals, a number of independent treatment centres and a number of hospitals in Germany and Belgium for medical specialist care that is reimbursed under the public healthcare insurance (note: not Supplementary insurance).

1.2 Points to note when purchasing

We look at a number of points when purchasing medical specialist care:

 

Quality

Care providers who offer medical specialist care have to be authorised and skilled in order to provide the care in question, regardless of whether we conclude a contract with them. After all, they have to be appropriately eligible/hold a permit and medical specialists have to have a valid BIG registration. Care providers that provide medical specialist care have to comply with nationally recognised treatment standards.

 

Nationally, care providers, healthcare insurers, patient associations and the Healthcare Inspectorate have formulated quality indicators with regard to whose results hospitals and independent treatment centres are obliged to report on an annual basis. Visit www.kiesbeter.nl and use these quality indicators to see how well hospitals/departments score on a number of disorders in terms of care and patient preference. Our online Care Comparison Tool offers reliable information about the quality of hospitals. With effect from 2012, the Quality Institute will publish the optional information about the quality of care on its website.

 

On the basis of these quality indicators, HollandZorg compared more than forty hospitals and came up with a ranking for ten common disorders/operations. We will use this information in our talks with the hospitals, like other information about how healthcare is organised for certain disorders. At the moment we contract all Dutch hospitals and a number of independent treatment centres. When hospitals fail on a number of aspects, we will come to an arrangement to improve matters.

 

HollandZorg applies the national minimum quality standards set by a number of professional associations of medical specialists (surgeons, urologists, etc.) for highly complex operations. Among other things, there is a minimum standard for the number of operations per year for certain disorders (e.g. breast cancer, intestinal cancer, liver surgery, lung surgery). Hospitals that cannot comply with this can no longer provide this care and will have to refer patients elsewhere. Visit www.minimumkwaliteitsnormen.nl to see if a hospital does or does not comply with these minimum standards.  

 

In addition to care-related performance indicators, it is also important to know how a patient experiences the care he receives at a hospital. This is surveyed by means of the so-called hospital care CQ-index. The results of these surveys are also important for the agreements we enter into.

 

Accessibility

HollandZorg rates accessible healthcare very highly. This means we contract enough care providers near you to offer you plenty of choice. Furthermore, in the case of a contracted care provider you can assume that the invoice will be settled directly between the care provider and HollandZorg. If you opt for a non-contracted care provider, please be aware of the fact that reimbursement rates may apply that require you to make an additional payment.

Accessibility also means that you can be seen to within an acceptable period of time. Acceptable waiting times have been agreed on a national level. If a hospital is unable to provide any care within this term, you can always ask if you can be seen to quicker elsewhere. We will be happy to help you out in that respect. Please call us on +31 (0)570 687 123.

 

Affordable healthcare in the region

In order to keep healthcare (and as such your premium) affordable, we aim to keep healthcare costs in the HollandZorg region in line with the national average. This means that the purchasing agreements made with hospitals also remain within a certain bandwidth in terms of cost development. We and the hospitals also look at how healthcare can be more efficient without compromising quality. Improving 'suitable use' by care providers is an important theme within this context too: does a patient receive too much or too little treatment? We also carry out checks on the correctness of invoices that have been submitted.

2. How is the choice of freedom organised for the insured?

With HollandZorg, you can select your own care provider. To date, we have been concluding contracts with all Dutch hospitals and a number of independent treatment centres for medical specialist care under the public healthcare insurance. Use our Care Finder to look for contracted hospitals, independent treatment centres and independent medical specialists for medical specialist care under the public healthcare insurance.

If you cannot find your preferred care provider, please call us on +31 (0)570 687 123.

2.1 Non-contracted healthcare

In contrast with hospitals, we do not conclude a (full) contract with every independent treatment centre or independent medical specialist. We carry out checks on the added value and accessibility, quality and price of these care providers and the extent to which our insured use them. If you opt for a non-contracted care provider, please be aware of the fact that reimbursement rates may apply that require you to make an additional payment.

More information can be found on reimbursement medical specialist care in 2013.

2.2 Medical specialist care abroad

If you want to visit a hospital abroad for non-emergency treatment, this is often possible. The principle is that it has to concern treatment that is covered by the public healthcare insurance in the Netherlands. There are many things you have to take into account in such cases. We therefore advise you to contact the Care Advice Line beforehand, so you know exactly what to expect. The extent of the reimbursement for the use of a foreign hospital is subject to a maximum of the competitive rate that applies to that care in the Netherlands.

 

To make it easier for you, HollandZorg has made arrangements with the Foreign Care Office (Zorgloket Buitenland). The employees with medical expertise know exactly which hospitals in Germany and Belgium you can visit for a certain treatment or operation. They also assist you from start to finish; some of the German hospitals even have Dutch-speaking assistants.

 

The patient's experience and satisfaction are verified later and the invoice for the medical costs is settled directly with HollandZorg. To contact the Foreign Care Office, you can call +31 (0)570 687 123. You can also ask them about your eligibility for reimbursement of transport costs and any accommodation expenses incurred by family members.

3. Improvement of care

HollandZorg and the care providers continuously aim to further improve the healthcare offered to its insured. A number of examples related to hospital care are listed below.

3.1 Integrated care

Care provided both inside and outside a hospital's walls or care that involves multiple healthcare provides anyway, has to be in line with each other to the greatest possible extent. In the Deventer region, we and the care providers are currently gaining experience with integrated care for diabetes, cerebrovascular accidents (CVA), dementia and chronic obstructive pulmonary disease (COPD). This may soon be followed by an integrated care programme for the prevention of cardiovascular diseases.

 

We also join integrated care programmes organised by the relevant healthcare insurers and care providers elsewhere in the country, so that you can make use of them too, wherever you live.

3.2 (Poly)pharmacy

In 2009, we started making arrangements with hospitals about medication in the hospital and how to coordinate this with the situation at home. The pharmacy service centre (ASP) documents which medication is used at home before a patient is admitted to hospital. During a hospital stay, the administration of medication is continuously updated in the system, and staff ensure no errors are made with the medication. When the patient is discharged, staff check if and which medication the patient must continue to take at home. This so-called 'discharge prescription' is given to the patient, while a written copy is sent to the patient's GP and pharmacy. Increased transparency about which medication is used in what situation serves to improve medication safety. Elderly people on a lot of medication (polypharmacy) are a particular risk group.

3.3 Oncology Knowledge Centre

After having been diagnosed with cancer, a patient's world is turned upside down and he will be overwhelmed. An increasing number of regions now have oncology centres or drop-in centres that offer support to people affected by this. Such support can relate to anything: information, advice, mental support, contact with fellow sufferers, or just a cup of tea or coffee. They also offer practical support, such as helping patients to find a wig. The centres often offer support in rebuilding the mental and physical condition after cancer, or helping patients cope with all that has happened to them. In the Stedendriehoek region, the Oncology Knowledge Centre in Schalkhaar aims to help people and their loved ones in these situations. HollandZorg has been involved since the centre was set up and fully supports its work.

4. More information

We are happy to help you further by giving you information about care providers. If you have any questions or issues, please contact us. You can call HollandZorg on working days on +31 (0)570 687 123 or send an e-mail.