Diederik Schrijvershof and Annabel Kingma successfully assisted Huisartsen Groep Eendracht (“HGE”) in the contracting of care for 2024/25. HGE was established in the fall of 2022 as a partnership (regional GP organization) of 15 practicing GPs in Bergen op Zoom, Roosendaal and Tholen. CZ and VGZ had decided not to offer HGE as a regional GP organization a contract for the year 2024 in segment 3. This would have far-reaching consequences for HGE, the general practitioners and their patients, as segment 3 includes the elderly care modules and the “more time for the patient”-module. If HGE did not receive a contract from CZ and VGZ, HGE's member GPs would not be able to provide the care within these modules.
Maverick Lawyers successfully assisted HGE. This included requests for enforcement with the Dutch Healthcare Authority (“NZa”) and the Authority Consumer and Market (“ACM”) regarding health insurers CZ and VGZ.
- The NZa enforcement request concerned:
- the violation of duty of care (article 11 Zorgverzekeringswet) by both CZ and VGZ;
- the violation by CZ of the Regulation on Transparency of the Healthcare Procurement Process under the Healthcare Insurance Act (“Healthcare procurement Regulation”) during the process of procuring GP care for 2023 and 2024. Pursuant to the Healthcare Procurement Regulation, healthcare insurers are obliged, among other things, to announce their healthcare procurement policy no later than April 1st. CZ applied exceptions to its 2024 purchasing policy, while CZ had not published these exceptions in the CZ purchasing policy. As a result, these exceptions were not known to all GPs. The NZa therefore concluded in its enforcement decision that CZ had indeed violated the Healthcare Procurement Regulation.
- The ACM enforcement request concerned the prevention of a collective boycott of HGE as a result of unauthorized coordination of the healthcare purchasing policy by CZ and VGZ. The ACM made it known to both CZ and VGZ during talks with the ACM that, under the cartel prohibition, CZ and VGZ are obliged to shape their care procurement independently and may not engage in any unauthorized coordination among themselves.
After the requests were submitted to the NZa and ACM, HGE's GPs obtained contracts with both CZ and VGZ for 2024. This was also in the direct interest of CZ and VGZ's policyholders, as they are entitled to timely and accessible general practitioner care under CZ and VGZ's healthcare (procurement) duty. The latter is certainly a hot topic not least because the NZa has also found that access to general practitioner care is increasingly under pressure.
For years, Maverick Advocaten has been advocating for adequate (enforcement of) mandatory rules for health insurers in the procurement of care and dealing with excesses of purchasing power of health insurers. For more information see here, here, here, here, here, here, here, here and here. For more information on the rights of healthcare providers and duties for healthcare insurers consult zorgcontractering.com.
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