NMa Rejects Complaints of Healthcare Providers against Health Insurers
The Netherlands Competition Authority (NMa) has rejected a large number of the complaints made by physiotherapists and general practitioners with regard to the refusal by health insurers to enter into negotiations with individual healthcare providers about their contracts. The healthcare providers complained to NMa about this and described this behaviour as an abuse of a dominant position by the health insurers. After conducting an investigation NMa concluded that this was not the case.
Complaints about the refusal to negotiate with individual healthcare providers
General practitioners and other healthcare providers argue that health insurers are required to negotiate with individual healthcare providers about their contracts. This is based on a misunderstanding. The Competition Act does not require health insurers to negotiate with individual healthcare providers, not even if the health insurer has a dominant position. Health insurers are at liberty to determine their own procurement policies, provided the criteria they apply are objective, transparent and non-discriminatory. Abuse may occur if the health insurer imposes unfair conditions, such as certain conditions in relation to payments or delivery.
Other complaints by physiotherapists
In addition, NMa received various complaints from physiotherapists with regard to the contents of the contracts offered.
Health insurer refuses to offer a contract only for the main insurance
Some health insurers only offer a contract for the main insurance in combination with a contract for additional insurance. In this regard, the health insurer may determine its own procurement policy as long as it meets the criteria of objectivity and transparency. In addition, there is an objective justification for offering a contract which combines both types of insurance. Since part of the physiotherapy falls within the main insurance policy and a different part falls within the additional insurance, combining them ensures that patients do not have to switch physiotherapists during their treatment.
Health insurers offer a fee which is too low
Physiotherapists complained that the fee offered lies below their cost price. NMa notes that there is oversupply in the physiotherapy sector. Recently health insurers increased their fees by approximately 10% to 15%. NMa therefore has no evidence that the health insurers have abused their procurement power.
Health insurer provides no extra payment for treatment at home
An insurer may opt to offer an all-in rate rather than a basic rate with additional fees. Since the level of the all-in rate offered by the health insurer is higher than the average rate of other health insurers, this is not an indication that they have abused their procurement power.
NMa takes action in the healthcare sector where the government wishes to promote competition. NMa focuses, in particular, on ensuring that the entry of new parties is not obstructed and that competition between existing parties is not restricted or distorted. The healthcare sector has priority in NMa's Agenda 2005.