Barend van Lieshout: David and Goliath battle it out in Amsterdam

The conflict between health insurer Achmea and the Slotervaart hospital in Amsterdam could have important consequences, writes Barend van Lieshout

The Slotervaart hospital and health insurer Achmea have not come to a contractual agreement, the two parties announced on Friday. It seems a mere dry, legal fact but these failed budget negotiations have much wider implications: they are pitching the small hospital against the biggest insurer, the entrepreneur against the macro-budget and consumer choice against the expert buyer who makes the decisions. The outcome of this fight will not only affect Amsterdam but the country as a whole.

Polder conventions

Both players are involved in a game of brinkmanship. The Slotervaart is operating in the oversaturated Amsterdam hospital market which, as the parties know, is set to become less crowded in the coming years. Maintaining an A&E department, volume and perspective is vitally important for the hospital.

Administrator/entrepreneur Aysel Erbudak has shown she knows what she wants and is not about to let polder conventions get in the way.

Achmea on the other hand knows that The Hague is getting impatient and wants to see health insurers buy healthcare much more responsibly and discerningly, and within the limits of the macro-budget. If Achmea loses this fight – even if the amount of money is relatively small – it will weaken its hard-fought negotiating power in the whole country.

Consequences for the patients

For the first time patients will be affected by a conflict between hospital and insurer. Without a contract, patients with a so-called ‘natura policy’ will not be compensated fully for treatment at the Slotervaart hospital. This is a tricky one for both parties: the Slotervaart doesn’t want to chase away patients by charging and Achmea doesn’t want its customers to go to insurers who do have a contract with the Slotervaart.

Both Achmea and the hospital are going out of their way to reassure their customers: Achmea is referring them to nearby hospitals and the Slotervaart is offering to compensate patients faced with higher costs.

At the moment policy holders don’t notice much of a difference between a restitution and a natura policy: the premiums are practically the same and so is the coverage because all the hospitals are still under contract. The thought behind the natura policy is that only the expert insurer can decide whether or not a hospital is delivering value for money. This conflict, however, is not over the quality of the Slotervaart hospital as a care provider but over the use of expensive medication. You may very well wonder if a limited access to expensive medication is what Achmea policy holders want.

The price of choosing your own doctor

The Slotervaart hospital and Achmea will be meeting in court. Then it will become clear who will have the upper hand during the negotiations. If the judge finds for the Slotervaart, the floodgates will be opened and the macro-budget won’t be tenable. If Achmea wins, policy holders will have to ponder the price of free choice.


  Barend van Liehout is a health advisor at Rebel

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