Occupational therapy healthcare purchasing

Our vision on healthcare: occupational therapy

 

Occupational therapy forms part of the healthcare that is covered by the public healthcare insurance (the Healthcare Insurance Act). In 2016, the maximum number of treatment hours that will be reimbursed is ten per calendar year.

 

The care reimbursed by HollandZorg is provided by healthcare providers who run their own surgeries and by healthcare providers who are affiliated with a home care agency, a nursing home or a disability care institution. Treatment can take place at the occupational therapist's surgery, but is often also provided at home, as the treatment provided by the occupational therapist focuses on your daily living conditions. Your family members may also get involved in this.

The content of the care is laid down in the 'performance descriptions for occupational therapy' policy rule of the Netherlands Care Authority.

1. Vision on healthcare

1.1 Why do we conclude agreements?

We conclude contracts with healthcare providers in order to guarantee they comply with the basic quality requirements and to ensure they make sure the care they provide is effective. This is all provided for in the contract. For the healthcare providers, a contract also offers favourable payment conditions.

1.2 Things to look out for when purchasing

There are a number of things to look out for when purchasing occupational therapy care:

Quality
When we conclude a contract with an occupational healthcare provider, our first requirement is that the occupational therapist is BIG-registered and that he is listed in the Paramedics Quality Register.

In addition, an occupational therapist has to demonstrate that he works according to the most recent guidelines and protocols of the professional association. This way, you will receive the most recent and suitable care. Other things we find important:

 

  • that a proper electronic patient file is kept;
  • that consultations are held with the person who referred you;
  • that regular customer satisfaction surveys are held;
  • that the focus is on the customer.

Privacy, continuous training, deputising arrangements and a good surgery organisation are also important for good quality and care.

 

The occupational group for occupational therapists recently started an objective measurement of quality and customer satisfaction using the CEE tool. Eno supports this development and as soon as the results are available, we will be reviewing them with the occupational therapists to see if and how they can affect our insured customers.

 

Accessibility
You are often referred to an occupational therapist by your GP or other physician. However, it is also possible to see an occupational therapist directly, provided he/she has followed specific training to that end (Direct Access). The occupational therapist will assess whether or not he/she can help you. By contracting a large number of surgeries, you will find an occupational therapist nearby in most cases and waiting lists will not be too long.

In terms of physical accessibility, we apply the setup requirements stipulated by our occupational group.

 

Effectiveness

Like most insurers, we are also confronted with rising healthcare costs. When costs rise, it will also affect the extent of the premium you pay. That is why our policy aims not just to safeguard quality, but also to act in a cost-effective way. We feel it is important to exchange views with contracted occupational therapists about the most effective treatment methods, the treatment objectives and the corresponding treatment period required. This information can help the healthcare provider to make arrangements with you, the insured, about your treatment.

2. What freedom of choice does the insured have?

You may choose any healthcare provider. In principle, HollandZorg takes out contracts with all occupational therapists who meet the basic quality requirements. This means there is always an occupational therapist available near you. You can find an occupational therapist using our Care Finder.

In addition to our contracted occupational therapists, you may encounter non-contracted care. They are surgeries that are unable to meet our basic quality requirements, or that opt not to conclude a contract with Salland Zorgverzekeringen.

HollandZorg applies maximum reimbursements for occupational therapy provided by non-contracted surgeries. We always recommend contacting your healthcare provider to find out if he has a contract with HollandZorg. You can also use our Care Finder to find out.

As soon as you have found a healthcare provider, it is wise to make arrangements with him/her about your treatment: what are the objectives? And how will these objectives be achieved?

3. Special/innovative arrangements

Although the discipline of occupational therapy is a fairly specific area of expertise, we encourage healthcare providers to improve and increase their collaboration with other disciplines within the healthcare sector. This is one of the ways in which we try to continue to improve our care provision to our insured customers.

4. More information

We will be happy to provide you with more information about our healthcare providers. If you have any questions or issues, please contact our care advice line on +31 (0)570 687 123 on working days. We will discuss your situation and offer you the best advice.