Transparency healthcare costs goes to court

In the Netherlands, it is currently almost impossible to get as a patient, tax and insurance premium payer insights into the costs of health care. This while the vast majority of health care costs is reimbursed from public funds.

Every Dutch citizen is obliged to contribute through insurance premiums and taxes to the huge national health costs. As the Dutch Minister of Health, Welfare and Sport, Edith Schippers, this year declared the Year of Transparency, however, this important aspect, the costs of healthcare is left aside.

Healthcare providers and insurers in the Netherlands provide no insight into prices charged and the number of treatments. In most cases, the invoices of treatments are forwarded directly to the health insurance companies and are only months after treatment only partially accessible for an individual patient. Moreover, too little is known about price differences between healthcare providers, whereas large differences can be perceived.

Therefore Open State Foundation’s Lex Slaghuis, assisted by investigative journalist and FOIA expert Brenno de Winter took this case to court.

Since the introduction of aspects of free market in healthcare, hospitals and other healthcare providers work with a billing system whereby they draw up a care product for a certain medical treatment; the so-called Diagnosis Treatment Combination. This DBC product brings all hospital costs from diagnosis to treatment.

Based on Dutch FOIA Open State Foundation filed a FOIA request in 2014 to obtain data on all health care claims in the database of the national DBC Information System which is under supervision by the Netherlands Healthcare Authority (NZa). The request includes data on rates, fees and declared health care costs. Additionally, the information request further asked to provide the data digitally in a machine-readable (open) format or as raw data.

Until now, the NZa refused to cooperate. According to the State Attorney, who is hired by the Nza, providing the data would weaken the competitive position of healthcare providers and decided that this information should be kept secret. However, people with a reimbursement insurance always pay for a treatment first and declare the costs afterwards. The prices of treatments for this group of citizens are known. In addition, patients with insurance claims can view reimbursements themselves. Additionally, patients can contact a health provider and ask for a quote.

Another reason the NZa brought forward to refuse transparency was privacy infringements. However, the database itself claims that DBC data are pseudonymised and that it is impossible to trace the data back to a private person. The Minister of Health, Welfare and Sport has confirmed this in answers to parliamentary questions related to this matter.

The court will hear the case this Thursday morning at the court of Amsterdam.

More information and all related documents can be found here.