Kroneman Madelon, de Jong Judith D
NIVEL (Netherlands Institute of Health Services Research), PO box 1568, 3500 BN Utrecht, The Netherlands.
NIVEL (Netherlands Institute of Health Services Research), PO box 1568, 3500 BN Utrecht, The Netherlands.
Health Policy. 2015 Mar;119(3):245-51. doi: 10.1016/j.healthpol.2015.01.013. Epub 2015 Jan 28.
With the introduction of the Health Insurance Act in 2006 in the Netherlands, the basic package of the former sickness funds became valid for all citizens. The basic benefit package has been subject to change, responding to increasing health care expenditures, medical innovations and the economic crisis. In this paper we address the decision criteria used to assess the package annually since 2006 and describe some developments that do not follow the criteria, leading to a yo-yo effect. We discuss the formation of the decision for in- or exclusion and why some treatments seem to follow an, at first sight, arbitrary in- and exclusion pathway. We first describe the official way of establishing the basic benefit package and than will describe why some treatments follow a deviated path. We conclude that political pressure and pressure from interest groups may lead to inclusion or postponement of exclusion. Reform of the organization of certain forms of health care (in our example mental care) may lead to seemingly inconsequent changes. The yo-yo effect of some treatments or pharmaceuticals may have negative effects on health care providers, insurers and patients. The seemingly well defined criteria available for defining the basic package appear to be broadly interpretable and other influences may determine the final decision of inclusion or exclusion.
随着2006年荷兰《健康保险法》的出台，以前疾病基金的基本套餐对所有公民都有效。基本福利套餐一直在变化，以应对不断增加的医疗保健支出、医学创新和经济危机。在本文中，我们阐述了自2006年以来用于每年评估该套餐的决策标准，并描述了一些不符合该标准的发展情况，从而导致了一种摇摆效应。我们讨论了纳入或排除决策的形成过程，以及为什么有些治疗方法似乎遵循一种乍一看随意的纳入和排除路径。我们首先描述确定基本福利套餐的官方方式，然后将描述为什么有些治疗方法会遵循偏离的路径。我们得出结论，政治压力和利益集团的压力可能导致纳入或推迟排除。某些形式的医疗保健（在我们的例子中是心理保健）组织的改革可能会导致看似不合理的变化。某些治疗方法或药品的摇摆效应可能会对医疗保健提供者、保险公司和患者产生负面影响。用于定义基本套餐的看似明确的标准似乎可以有广泛的解释，其他影响因素可能会决定最终的纳入或排除决策。
