OP0143-PARE Patient Advocacy: Patient Choice in Dutch Healthcare

Background Choosing a health insurance package every year is a very complex matter for Dutch arthritis patients, especially if they see multiple specialists, hospitals and other healthcare providers. This is because every year Dutch private health insurers decide again whether the quality and the price of care in a hospital is high enough to contract them in one of their 1300 health insurance plans. Up till now, when patients chose or needed non-contracted care, health insurers were legally obliged to reimburse up to 70%. For budget reasons, the Dutch government wishes to change this, enabling health insurers to reduce this reimbursement to as far as 0% for non-contracted care in (cheaper) health insurance plans. This is very bad news for arthritis patients who cannot afford to pay a more expensive health insurance plan in which most, or all, healthcare providers are contracted. For them, patient choice will become restricted. Objectives Many arthritis patients develop long-term relationships with their rheumatologists, hospitals and other healthcare providers. Therefore, the Dutch Arthritis Foundation finds that all arthritis patients should have the right and responsibility to not only choose their health insurer but also choose which healthcare providers they see. Rheumatologists and other specialists play an important role in the quality of rheumatological care. An early diagnosis, the right treatment and a second opinion can even save money. The difficulty is that clear and comparable information on the quality of rheumatological care, on which insurers and patients can base their choices, is still scarce. Consequently, we believe that arthritis patients will benefit more from investing in quality and clear information than from restricting access to non-contracted healthcare. Methods In June 2014, we started an advocacy campaign on our website, Facebook and Twitter. Following that, we expressed our concerns in a parliamentary hearing and in a position paper. Moreover, with 70 other organisations, we asked arthritis patients to sign an online petition asking the parliament to stop this legislation. In the autumn we sent a letter to the Senate, also asking for more transparency from health insurers about their contracting and quality policies. In December the online petition, with 160.000 signatures, was handed to members of the Senate. Following months of public concern and media coverage, the debate in political parties heated up too and the Senate failed to approve the legislation. Results During the past years, much of our advocacy and awareness campaigns have focused on the need to empower patients with a chronic disease, such as arthritis, in the increasingly complex healthcare system of the Netherlands. Perhaps not surprisingly, the government plans to restrict patient choice of health providers drew a bitter response from arthritis patients. By using various advocacy strategies, online and offline, we were able to address the importance of access to high quality care for arthritis patients, whether that care is contracted or not. Conclusions People with chronic diseases, such as arthritis, have growing difficulties to find their place in the Dutch health system. It was great to work together with so many organisations and arthritis patients and share our concerns. Although the advocacy for patient choice has not finished yet; the government works on renewed legislation. Disclosure of Interest None declared