Medical specialist care 

Our vision of healthcare: Medical specialist care

Medical specialist care is care such as medical specialists generally provide. Hospital care is a broad concept; all institutions that are approved for this by the Ministry of Health, Welfare & Sport fall under this concept. Examples include general hospitals, university hospitals, independent treatment centres (ZBCs), rehabilitation centres and radiotherapy centres (radiation).

Are you a care provider?

HollandZorg is part of Eno Zorgverzekeraar. You will find our purchase policy and the principles of this policy on the Eno website.

 

1. Vision on healthcare purchasing

1.1 Why do we conclude agreements?

We conclude agreements with care providers to ensure that they deliver customer-oriented, high-quality and efficient care. Also, we enter into discussions with care providers about the price of care. We believe it is important that quality and efficiency come first and that care remains affordable. This is documented in the agreement.

 

We conclude contracts with all Dutch hospitals and several independent treatment centres for specialist medical care that is reimbursed under the public healthcare insurance.

 

As from 2018, we no longer conclude contracts with foreign hospitals. You can still go abroad for treatment. More information about reimbursement of healthcare abroad can be found on the page about healthcare abroad.

1.2 Things to look out for when purchasing

We pay special attention to expensive medicines in our purchasing policy. Expenditure on expensive medicines is increasing every year. To keep healthcare accessible and affordable, we expect care providers to apply a competitive price and to use the medicines efficiently.

1.3 Requirements for care providers and care provision

Care providers who provide specialist medical care must be authorised and competent to provide the relevant care, regardless of whether we conclude an agreement with them. At the very least, there must be an appropriate admission/licence and medical specialists with a valid BIG registration. Care providers who provide specialist medical care must adhere to nationally recognised treatment standards.

 

Quality of care

National minimum quality standards have been drawn up for highly complex procedures (for example, for breast cancer, colon cancer and liver surgery). Care providers who do not comply with this are no longer allowed to offer this care and refer patients to a care provider who does meet the standards. We agree with this and only contract these procedures with care providers who meet the minimum quality standards.
 

In addition to meeting the minimum quality standards, we believe it is important that care providers are transparent about the quality they deliver. For us, it is a condition that a care provider participates in all relevant national quality registrations (for example, DICA). We also encourage participation in patient satisfaction surveys (for example, CQIs, PREMS, PROMS).

 

Accessibility

Accessible care is very important to us. This means we contract sufficient care providers in your area to offer you freedom of choice.


Accessibility also means that you can see someone within an acceptable period. Nationally acceptable waiting times have been agreed on. If a hospital is unable to provide care within this period, you may be able to see another care provider quicker. We are happy to help you with this. 

 

Affordable care

To keep healthcare (and thus your premium) affordable, our goal is to keep healthcare expenses in line with the national average. This means that purchasing agreements made with hospitals also remain within a certain bandwidth in terms of cost development. We are also working with hospitals to examine where healthcare can become more efficient, without compromising quality. The promotion of ‘Appropriate use’ by care providers is also an important theme in this context: is there any over or under-treatment? We also carry out checks on the correctness of submitted invoices.

2. What freedom of choice does the insured have?

We conclude agreements with all Dutch hospitals and several independent treatment centres for specialist medical care under the public healthcare insurance. If you go to a provider contracted by us, you will be fully reimbursed for the treatment (provided it is covered by the public healthcare insurance).

 

In contrast to hospitals, we do not conclude a (full) agreement with every independent treatment centre or independent medical specialist. If you choose a non-contracted provider, we reimburse a maximum of 75% of our average contracted rate. In most cases, you will have to pay part of the treatment yourself.

 

You can use our care finder to find hospitals, independent treatment centres and independently established medical specialists. It also tells you whether we have entered into an agreement with the relevant care provider. If the care provider of your choice is not listed, you can contact our customer service department on +31 (0)570 687 123 to inquire about alternatives.

3. More information

We will be happy to provide you with more information about our care providers. If you have any questions or issues, please contact our Customer Service department on +31 (0)570 687 470 on working days. We will discuss your situation and offer you the best advice.