ACM: joint COVID-related arrangements only allowed if nationwide continuity of health care provision is at risk
Going forward, hospitals and health insurers are only allowed to make joint arrangements regarding the reimbursement of COVID-19-related costs if the nationwide continuity of health care provision is seriously jeopardized. That is one of the conclusions of the Netherlands Authority for Consumers and Markets (ACM) in its response to the proposed arrangements that hospitals and health insurers have made for 2022 with regard to COVID-19. After two years of the pandemic, hospitals and health insurers are now well able to assess the risks of new COVID-19 waves. Hospitals are able to make arrangements with health insurers one-on-one. Bilateral arrangements allow for customized solutions, and can take into account specific individual and/or regional situations as much as possible.
Just like last year, Zorgverzekeraars Nederland (ZN, an umbrella organization of health insurers in the Netherlands), the Netherlands Federation of University Medical Centres (NFU) and the Dutch Hospital Association (NVZ) asked ACM for its opinion about the compatibility of their arrangements with competition rules. In January, ACM already indicated not to have any objections against the broad strokes of the new arrangements that were published in late 2021. In mid-June, the newest version of the agreement was submitted to ACM.
What was this case about?
For the years 2020 and 2021, ACM allowed the joint arrangements between hospitals and health insurers because of exceptional circumstances. These arrangements concerned reimbursements of the costs associated with the treatment of COVID-19 patients, and were necessary for safeguarding the continuity of health care provision. For ACM, it was important that the arrangements were temporary, and that the parties to the agreement wished to return to regular bilateral negotiations as soon as possible.
ACM has established that, in the fall of 2021, individual negotiations were being held in earnest. However, these negotiations were abruptly disrupted by the extraordinary and unexpected severity of the Omicron variant. The three trade associations then decided to contact each other in order to make a set of joint arrangements on top of the bilateral contracts with regard to mitigating the financial effects of the COVID-19 pandemic on hospitals. In that context, several arrangements were made regarding the reimbursement of production losses caused by COVID-19 for the period up to and including April 2022.
What is ACM’s opinion?
ACM recognizes that the joint arrangements for the first months of 2022 were necessary for safeguarding continuity of health care, and for having some extra time to finalize the bilateral health care contracts between hospitals and health insurers for 2022. In addition, the joint arrangements for 2022 are more specific and go less far than those for 2021.
Joint arrangements regarding production losses after April are not necessary, according to ACM. It is possible to include arrangements regarding reimbursement of production losses caused by COVID-19 in the regular bilateral contracting cycle. Previous experiences and schemes have made everyone familiar with the different aspects of the effects of production losses on hospitals. Health insurers and hospitals, too, indicate that there is sufficient confidence that, in the future, it is possible to make arrangements regarding this issue through bilateral contracting.
ACM believes that new arrangements can only be made in special, new circumstances, in which the impact of COVID-19 hits the hospital landscape in such a way that a disruption to our health care system becomes a looming threat. ACM will soon sit down with ZN, as well as with NVZ and NFU and discuss their responsibilities and roles when initiating joint arrangements. That should ensure that the regular negotiations between health insurers and hospitals are not delayed or postponed.