Implementing the Basic Health Package in The Netherlands

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Implementing the Basic Health Package in The
Netherlands André den Exter
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Legal context BHP

• Health Insurance Act (Zvw, 2006), Exceptional
  risks scheme (AWBZ)
• Insured risks functional approach
• Nature and scope Ministerial Acts and insurance
  policies
• Health Care Insurance Board (CVZ) Package
  management annual package advice
• Whats in and whats out?
• Package principles

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Relevant developments

• Role of Health insurance companies
• Preference policy
• Guidelines and protocols medical associations
• Council of Quality and Care Towards a Dutch
  NICE?

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Comments

• Lack of civic engagement
• Rational democratic deliberation

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Effects Zvw Towards a fair rationing debate?

• Rationing under the Zvw scheme
• Rationing decisions in practice less explicit
• Decisionmaking based on merite instead of
  medical need
• Priority health care arrangements

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To conclude

• Equity without efficiency is unaffordable
  efficiency without equity is iniquitous.
• Leonard Fleck. Just Caring. Health care rationing
  and democratic delibaration, OUP 2009, 401