Suppose you need a new hip. In principle, you go to a hospital that has a contract with your insurer. This will then reimburse the costs directly to the hospital. But you can also choose to go to a non-contracted care provider, for example because the waiting list is shorter there. You then pay the invoice and the insurer must reimburse you for part of the costs. The government wants this reimbursement for non-contracted care abolish.
The reason for this is that in some healthcare sectors there are many non-contracted healthcare providers, for example in mental health care and community nursing. Non-contracted care costs health insurers a lot of money. The abolition should therefore save costs.
In itself, the government’s plan is understandable. But in trying to tackle a domestic problem, it has paid too little attention to the European consequences. European law stipulates that people can also receive care across the border at the expense of their insurer, provided that certain conditions are met. Such treatment across the border falls under the free movement of services in the EU. The government also realizes this. The solution it came up with for this problem just doesn’t make sense.
Most people opt for a so-called in-kind policy. With such a policy, the intention is that you receive care from a healthcare provider with which your insurer has entered into a contract. Such a contract, for example, contains agreements about the price of a specific treatment.
Expensive refund policy
Hernia surgery can currently also be performed in Cologne or Leuven. But most European healthcare providers are not contracted. Health insurers then pay the same reimbursement for non-contracted care in the Netherlands.
If the government’s plan goes ahead, you will no longer receive reimbursement for the same treatment in Cologne or Leuven. This is contrary to European law. After all, Member States may not hinder free movement.
The government plan gives health insurers a lot of power: without a contract, no reimbursement
As it stands now, the government wants to solve this by obliging health insurers to offer a reimbursement policy. Insurers have no longer offered these expensive policies since 2025. With such a policy, you as an insured person received full reimbursement, whether you went to a contracted or non-contracted healthcare provider. The government therefore seems to want to say: people who want to receive care in the EU should take out an expensive reimbursement policy.
The government seems to forget that the European reimbursement obligation applies to all types of health insurance policies. No reimbursement at all if you have a kind policy for care across the border is still an obstacle to the free movement of services. The fact that you could also have taken out a refund policy does not change this.
The government will therefore have to adjust the plans at this point, without infringing European law. A simple solution is for insurers to still reimburse cross-border care (under Dutch conditions as insured care and a referral by the GP). In other words: a part of the reimbursement policy in the in-kind policy, but only for foreign care. This is also how some other Member States, such as Ireland and Italy, approach it. Non-contracted care in the Netherlands does not then have to be reimbursed. European law says nothing about that.
The government plan gives health insurers a lot of power: without a contract, no reimbursement. This can force healthcare providers to sign unfavorable contracts. In addition, there is also something called free choice of doctor in the Netherlands. In addition to the European objections, there are plenty of other hurdles for the cabinet. After all, whether healthcare providers and patients are happy with the plan is a completely different story.
