Diederik Schrijvershof, Annabel Kingma and Cleo Habraken filed an enforcement request with the Dutch Healthcare Authority (“NZa”) on behalf of NVOS-Orthobanda (“NVOS”). This request points the NZa to a number of violations of both the Regeling transparantie zorginkoopproces Zvw (“Healthcare Procurement Regulation ‘) and the guidelines from the Handvatten Contractering en Transparantie gecontracteerde zorg (“Handvatten contracting”) by health insurer Salland (“Salland”). Salland did not provide sufficient justification for the 2025 contract offer. This is contrary to article 6.3 of the Healthcare Procurement Regulations. In addition, after having amended the contract offer several times, Salland wrongfully applied a very limited indexation for wage and price adjustments for the year 2026. It is also unclear how Salland incorporated the Government Contribution to Labor Cost Development (“OVA”) into the rates. This also violates Article 6.3 of the Healthcare Procurement Regulations. On top of that, Salland fails to motivate why indexation is not applied. In addition, Salland violates article 8 of the Regulation for 2025 and 2026 by failing to motivate in the announcement that the healthcare purchasing policy has been changed and to motivate which (major) changes this concerns. Finally, Salland also violates Article 5.1 of the Regulation by refusing to respond clearly and substantively to questions and comments from care providers within two weeks up to the time the contract is concluded.
NZa Healthcare Procurement Regulation
In practice, it is very important for healthcare providers that the healthcare insurer provides sufficiently clear and timely reasons as to why a contract offer includes markdowns in pricing. All the more so because the STAR judgment shows that healthcare purchasers must always take into account the legitimate interests of healthcare providers and, in that context, may not systematically refuse to index contracts. Read more about the STAR judgment here. The NZa has previously made it clear (such as here and here) that it will take stricter action against (persistent) violations of the Healthcare Procurement Regulations. The importance of sufficient transparency during the contracting process is also emphasized in the guidelines of the NZa's Handvatten contractering.
The NZa has previously imposed formal warnings on several health insurers for violating the Healthcare Procurement Regulations. For example, the NZa recently warned VGZ and earlier Zorg en Zekerheid, CZ, Zilveren Kruis, Menzis, EUCARE and DSW for violations of the Healthcare Procurement Regulations. VGZ and Zilveren Kruis were also previously fined by the NZa for violations of the Regulation.
For years, Maverick Advocaten has been advocating in favor of adequate (enforcement of) mandatory rules for health insurers in healthcare procurement and addressing the excesses of purchasing power of health insurers. For more information see here, here, here, here, here, here, here and here. For more information on the rights of healthcare providers and duties for healthcare insurers consult healthcarecontracting.com. And in this (video) briefing, see why under the STAR ruling, healthcare purchasers are required to consider increased costs at healthcare providers in their healthcare procurement.
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