Basic health insurance expanded again in 2016

As in previous years, Minister Edith Schippers (Public Health) does not remove treatments from the basic health insurance in 2016. Schippers does conditionally add a promising new treatment and a promising new drug to the basic health insurance from July 1, 2015. She has also appointed three new treatments as potential candidates for conditional admission. Prenatal surgery for spina bifida can also be reimbursed under certain conditions.

Thanks to the open system of basic health insurance, many new treatments and medicines automatically enter the insurance every year. Treatments that meet the "state of science and practice' are automatically reimbursed by health insurers.

Prenatal surgery for spina bifida

On 9 April 2015, the Netherlands Health Insurers informed the Care Institute that operation of fetuses with spina bifida can be reimbursed under certain conditions. This treatment is currently only possible in Leuven. Each year, 1 to 2 women are eligible. Health insurers have indicated to pay for the treatment in Belgium in some cases, as requested by the Minister, provided that there is a carefully defined cause and triage from a Dutch University Medical Centre.

Prenatal Testing

In the Netherlands, Non Invasive Prenatal Tests may only be performed and reimbursed after a positive result of a combination test. However, there are women in other countries where the NIPT may be performed without a prior combination test at their own expense. If this test has a positive result, they are technically not currently eligible for reimbursement of any follow-up tests. This issue is removed as of 1 January 2016.

Conditional admission

On July 1, 2015, one treatment and one drug are conditionally admitted to the basic health insurance. By allowing treatments and medications conditionally into basic health insurance, patients get access to these promising forms of care and insight into the effectiveness and cost of this care is gained. These are:

  • Belimumab (Benlysta). This is a drug for SLE, an incurable autoimmune disease. It is intended for patients with high disease activity who are not responding to standard treatment. 
  • Treatment with tumour infiltrating lymphocytes (TIL). This is a new treatment for patients with metastatic melanoma. At this time, these patients can only be treated with expensive medicines which are not effective for all patients and/or could result in a lot of side effects. 

Minister Schippers has designated three medical treatments as "potential candidates" for conditional admission to the basic health insurance. The Minister decides at a later date whether they are actually admitted conditionally. This decision is taken on the basis of further development of the research proposal and agreements between parties in the field. This can mean that one or more of these candidates eventually do not make it and are not conditionally introduced.

It involves the following treatments:

  • The treatment of intractable chronic cluster headache with a particular form of nerve stimulation. 
  • The treatment of patients with a particular genetic form of breast cancer (BRCA1) with high doses of a particular form of chemotherapy and stem cell transplantation.
  • The treatment of patients with gastric cancer and metastases in the peritoneum and/or abdominal fluid with a combination of a particular surgical procedure and a particular type of chemotherapy (HIPEC). 

Technical changes

In addition, a number of technical changes to the basic health insurance will be made in 2016. These are technical changes to ambulance transport for youth mental health care and seated medical transportation to intensive child care. It also involves a terminological change of 'dietary advice' to 'nutrition'. In addition, an adjustment is made for the reimbursement of invasive diagnostics after prenatal screening.

Publicatiedatum: 15 juni 2015
Daniel Dancewicz Directeur Inkoop & Internationaal
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