In addition to advising on the standard health care benefit package, the National Health Care Institute also advises on the health care system as a whole, i.e. is treatment so expensive that people would be unable to pay for it themselves?Įffectiveness: is there evidence that a given treatment works?Ĭost-effectiveness: is the ratio between the costs of a treatment and its results acceptable?įeasibility: can the inclusion of a given treatment in the package be realised in practice? The National Health Care Institute always asks the following questions when advising on the contents of the basic health care package: Such questions are referred to as package criteria. For example, care may be so cheap that people could pay for it themselves, or care may be so expensive that we may not be able or willing to pay for it collectively. In general, effectiveness is not what is open to discussion, but whether there are other reasons for querying the inclusion of certain care in the basic package. The National Health Care Institute advises the Minister of VWS on whether to include medicines in the basic package, and also about other package-related questions. The National Health Care Institute also acts as an adviser, both regarding the basic health care package’s contents and the health care system as a whole. This may mean that treatment is reimbursed for one disorder but not for another, simply because the treatment’s effectiveness has not been proven for the other disorder. Health insurers may only reimburse such treatment under the basic insurance if the National Health Care Institute has issued a positive assessment outcome.Īssessment outcomes always involve a treatment–disorder combination. In such cases the National Health Care Institute acts as a ‘referee’ and issues a so-called assessment outcome. When new treatment is involved, uncertainty may exist about whether it is sufficiently effective. These are only included in the basic package after the National Health Care Institute has issued positive advice and the Minister of Public Health, Welfare and Sport (VWS) has converted that advice into a positive decision.

This does not apply to pharmacy-supplied medicines.

In general, care is automatically included if its effectiveness has been proven. In order to be included in the basic package, care must, above all, be effective: evidence must show that care does what it is meant to. As an independent organization in the field of determining the contents of the basic package, the National Health Care Institute plays an important role in safeguarding these requirements. At the same time the government must ensure that health care is, and remains, accessible and affordable. The cover provided by these two laws is referred to as the basic health care package.īecause these are statutory forms of insurance for which everyone pays premiums and taxes, the government must ensure that the basic package includes care that is necessary and that works. The Health Insurance Act (Zorgverzekeringswet, Zvw) and the Long-term Care Act (Wet langdurige zorg, Wlz) describe which care this basic insurance covers. This is why every person in the Netherlands is statutorily insured for health care costs. The National Health Care Institute ensures a well-balanced basic health care package, so that we pay collectively only for care that actually works.

Clarify systems