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ACM: health insurers in 2021 may still distribute the additional costs related to the COVID-19 pandemic among each other

Health insurers this year may still distribute the exceptional additional costs related to the COVID-19 pandemic among each other. This has been the answer of the Netherlands Authority for Consumers and Markets (ACM) in response to questions posed by ZN (Zorgverzekeraars Nederland, an umbrella organization of ten health insurers in the Netherlands). However, in part because of ACM’s response, the thresholds below and above which costs may not be distributed have been raised significantly compared with last year. This year, health insurers individually will need to absorb more risks before they can benefit from this scheme.

Martijn Snoep, Chairman of the Board of ACM, adds: “We have taken a critical look at this scheme. We understand the need for such a scheme because in 2021, too, there were still many uncertainties about the impact of COVID-19, and it was necessary for health insurers to cooperate in order to guarantee the continuity of health care and to avoid significant disruptions to the Dutch health care system. At the same time, dealing with risks is the core businesses of health insurers, and we can no longer speak of an unknown and extraordinary situation. For this year, that first aspect was the deciding factor. However, as far as we are concerned, this will be the final year in which health insurers make collective arrangements regarding the distribution of the most disruptive costs related to the pandemic”.

What is ACM’s opinion?

Arrangements regarding the financial settlement of costs among health insurers are a violation of competition rules. However, the outbreak of COVID-19 in the spring of 2020 created an unprecedented level of uncertainty as well as an immense sense of urgency. In order to ensure the continuity of health care and to avoid significant disruptions to the health care system, ACM decided not to take action against the health insurers’ agreement to distribute the additional costs related to the COVID-19 pandemic among each other in 2020.

In 2021, too, there is still considerable uncertainty regarding the impact of the COVID-19 pandemic on hospitals and health insurers. In order to ensure the continuity of health care and to avoid significant disruptions to the health care system, ACM has therefore decided not to take action at this point against health insurers for their agreement this year. In that context, ACM finds it important that health insurers have acted on ACM’s warning to limit the collective scheme to what is most necessary. Compared with 2020, individual health insurers bear substantially more risks in order to absorb the effects of the COVID-19 pandemic. As a result, they continue to have sufficient incentives to procure health care efficiently. Another important aspect for ACM is that ZN has stated to ACM that both the health insurers as well as the health care providers now wish to return to regular individual contracting, with due regard to COVID-19.

ACM and the COVID-19 pandemic

The laws that ACM enforces offer much latitude for cooperation in order to prevent people and businesses from being harmed by the COVID-19 pandemic. Various businesses and trade associations have asked ACM questions about collaborations in times like these. ACM will not take any enforcement action if collaborations are essential to the protection of the general interests of people and businesses.