the Netherlands
In the Netherlands EHFCN has several members:
- Zorgverzekeraars Nederland (ZN) – Health Insurers Netherlands
- Nederlandse Zorgautoriteit (NZa) – Dutch Health Authority
- Criminal Investigation department of the Dutch Labour Authority, Ministry of Social Affairs and Employment (NLA)
- Infomation Hub Healthcare Fraud (IKZ)
Health Insurers Netherlands (ZN)
Zorgverzekeraars Nederland
Zorgverzekeraars Nederland (ZN) is the umbrella organization of ten health insurers in The Netherlands. They are: a.s.r., CZ, DSW, EUCARE, Menzis, ONVZ, Salland Verzekeringen, VGZ, Zilveren Kruis en Zorg en Zekerheid. ZN supports its members by fulfilling the mission of the Dutch health insurers: to arrange health care of good quality for their insured, that is affordable and accessible at the same time and aimed at promoting the well-being of their insured.
Values
As social entrepreneurs, the ten Dutch health insurers defend the interests of their insured. ZN on the other hand, as the umbrella organization of the Dutch health insurers, supports its nine members through public advocacy and offering services of common interest to the members. In doing so, health insurers apply the following values:
- Solidarity and equal access to health care for everyone are the of the Dutch private health insurance system;
- Health insurers strive for continuous improvement of the quality of health care, well-being and quality of life for the insured;
- Health insurers actively engage in ensuring effectiveness in health care and cost control in health care;
- Health insurers put reliability, good service and ease and convenience first, both for the insured as for the health care providers. The main principles hereby are: Certainty, minimizing the administrative burden for health care providers and taking care of reliable information for the insured and the health care providers.
- Lastly, health care insurers are not primarily focused at making profit. Entrepreneurship and competition between the health care insurers must lead to affordable and better care, thereby offering different options and choices for the insured.
History
ZN was established on January 1, 1995 as a result of a merger of the former Vereniging van Nederlandse Zorgverzekeraars (VNZ) and the Kontaktorgaan Landelijke Organisaties van Ziektekostenverzekeraars (KLOZ).
For more information about the Dutch healthcare system, please visit: https://www.government.nl/topics/health-insurance
| Priority | Action Areas | Category | Example |
|---|---|---|---|
| 1 | Prevention | Compliance to regulations | Both soft and hard |
| 2 | Detection | Compliance to regulations | Data access, legal aspects, tools, .. |
| 3 | Action | Compliance to regulations | All types of action once fraud is detected |
| 4 | Medical Check | Avoid waste/overconsumption | Overutilization of services – no medical evidence |
| 5 | Financial Check | Avoid waste/overconsumption | Overly expensive services |
Dutch Health Authority (NZa)
Nederlandse Zorgautoriteit
The Dutch Health Authority (NZa) is an autonomous administrative authority, falling under the Dutch Ministry of Health, Welfare and Sport (VWS). The duties and tasks of the NZa have been laid down in the Healthcare Market Regulation Act. The NZa has over 500 employees.
The NZa protects the interests of citizens with regard to accessibility, affordability, and quality of health care in the Netherlands. With that in mind, the NZa sets rules, regulates health care providers and health insurers, and gives advice to the Ministry of Health, Welfare and Sport (VWS). The NZa puts the interests of citizens first in anything it undertakes.
The NZa sets the tariffs and the treatment descriptions/specifications in the health care market
The NZa determines what types of health care can be charged to patients by health care providers, and what such health care may cost (at the most), for example treatments by GPs or dentists, or health care provided to people with disabilities. For most treatments, health insurers and health care providers sit down and make arrangements about what each treatment entails, what its quality should be, and what its price can be.
The NZa regulates health insurers and health care providers
Based on (risk) analyses of its own and on reports filed by consumers, the NZa checks whether health care providers and health insurers comply with the rules and regulations. For example, health insurers must accept everyone for the basic health insurance package, regardless of age, income, lifestyle or health. Also, health care providers must charge their treatments to patients correctly and their financial management must be transparent. In addition, health care providers are required to provide clear information about the price and quality of the health care they offer. Are the interests of consumers at issue? Then the NZa will step in.
The following are the five most important areas of healthcare fraud, corruption, and waste, ranked in order of importance according to the NZa. This ranking reflects not only the institution’s priorities by choice but also its scope of authority.
| Priority | Action Areas | Category | Example |
|---|---|---|---|
| 1 | Detection | Compliance to regulations | Data access, legal aspects, tools, .. |
| 2 | Action | Compliance to regulations | All types of action once fraud is detected |
| 3 | Prevention | Compliance to regulations | Both soft and hard |
| 4 | Financial Check | Avoid waste/overconsumption | Overly expensive services |
| 5 | Medical Check | Avoid waste/overconsumption | Overutilization of services – no medical evidence |
Criminal Investigation department of the Dutch Labour Authority, Ministry of Social Affairs and Employment
Opsporingsdienst NLA Nederlandse Arbeidsinspectie
The Criminal Investigation department of the Dutch Labour Authority is one of the special investigation services within the Dutch central government. One of the priorities is doing criminal investigations in healthcare fraud. Complex financial constructions are almost always involved and we regularly encounter organized crime
| Priority | Action Areas | Category | Example |
|---|---|---|---|
| 1 | Action | Compliance to regulations | All types of action once fraud is detected |
| 2 | Detection | Compliance to regulations | Data access, legal aspects, tools, .. |
| 3 | Prevention | Compliance to regulations | Both soft and hard |
| 4 | Financial Check | Avoid waste/overconsumption | Overly expensive services |
| 5 | Medical Check | Avoid waste/overconsumption | Overutilization of services – no medical evidence |
Information Hub Healthcare fraud (IKZ)
Informatie Knooppunt Zorgfraude
Many billions of euros are spent in the Netherlands on healthcare, intended for needy and vulnerable people in society. By handling healthcare money carefully, we keep healthcare affordable. The Information Hub Healthcare fraud (IKZ) investigates and shares reports about healthcare fraud and identifies trends and developments. So that fraud is detected and handled better and more effectively.
| Priority | Action Areas | Category | Example |
|---|---|---|---|
| 1 | Medical Check | Avoid waste/overconsumption | Overutilization of services – no medical evidence |
| 1 | Financial Check | Avoid waste/overconsumption | Overly expensive services |
| 2 | Action | Compliance to regulations | All types of action once fraud is detected |
| 5 | Detection | Compliance to regulations | Data access, legal aspects, tools, .. |
| 5 | Prevention | Compliance to regulations | Both soft and hard |