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Lack of clarity regarding contracted health care as well as emphasis on price pose risks for insured

When deciding to switch or not to switch health insurance policies, more than one in three insured were not aware that negotiations over reimbursable health care were still ongoing between health care providers and health insurers. In addition, 70 percent of insured that switched this year did so because of the prices of the plans. These are some of the results from the consumer study into the 2023 health care market conducted by the Netherlands Authority for Consumers and Markets (ACM). Lack of clarity regarding contracted health care as well as emphasis on price carry risks that the health care policies do not meet the expectations or needs of insured. ACM believes it is important that health insurers and health care providers finish their negotiations by November, thereby ensuring that insured are able to take into account information about reimbursable health care when choosing their health insurance plans. The Dutch Healthcare Authority (NZa) made a similar call on health insurers to offer insured more clarity during the switching period at the end of each calendar year.

No clarity regarding contracted care providers

During the most recent switching period, many health care providers and health insurers were still negotiating about possible contracts for 2023. As a result, health insurers were not able to provide clarity during the switching period about what health care providers were or were not contracted for care in the basic health insurance policy or in the additional insurance policies. Such uncertainty can lead to awkward situations for insured, for example, if an insured individual with a health insurance plan that primarily or only covers contracted health care (in-network care) visits a clinic with short waiting lists with which that individual’s health insurer does not have a contract. In such cases, the patient might have to pay the costs of the treatment completely or partially out of pocket. In order to prevent such situations, health care providers must inform patients as clearly as possible prior to any treatment. This year, the NZa will tighten its regulation regarding transparency among health care providers (in Dutch: Regeling transparantie zorgaanbieders) regarding this issue.

Comparing health insurance policies is difficult

Many insured find choosing a health insurance policy quite an undertaking. More than 1 in 2 respondents experienced difficulties comparing different policies. This could lead to choices that do not meet the expectations or needs of the insured individual.

Conversely, comparing prices is easier, and many have done so. The study shows that many respondents took action as their pocketbook expenses had gone up, and they were looking for ways to save money. Seven in ten respondents that have switched cite ‘price’ as the reason for switching. In addition, switchers also take a critical look at additional insurance policies: switchers are less likely to take out additional insurance policies than non-switchers.

To allow insured to choose the health insurance policy that best meet their needs, it must be clear in advance what health care providers offer full or partial reimbursements of health care in addition to prices. Health insurers, health care providers as well as comparison sites must continue doing their best to make sure that is the case.

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