Contract policy 2021-2025
CONTRACT POLICY 2021 – 2025 ZORGVERZEKERING BES (BES HEALTHCARE INSURANCE)
The Care and Youth Caribbean Netherlands Programme Directorate (in Dutch: programmadirectie Zorg en Jeugd Caribisch Nederland (hereinafter ZJCN)) of the Ministry of Health, Welfare and Sport (in Dutch: Ministerie van Volksgezondheid, Welzijn en Sport, hereinafter VWS) is responsible for the implementation of the healthcare insurance on the islands Bonaire, St. Eustatius and Saba (BES). The ZJCN is committed to achieving the VWS’s motto in the BES islands: ‘Care for people in a healthy society’. The ZJCN realises this in a fair, efficient and transparentway. The ZJCN’s contract policy for the period 2021-2025 provides frameworks and guidelines for the contracting of different types of healthcare providers for the period 2021-2025. Our procurement policy informs you about what you may expect from us in the framework of the contract policy and what we expect from you as a healthcare provider. We hope we can reach agreements with you which will lead to the best care, now and in the future.
People insured with us are entitled to managed care. This means that persons insured with the ZJCN can receive care without patient contribution in conformity with the Besluit zorgverzekering BES (BES Healthcare Insurance Decree) and the derivative Regeling aanspraken zorgverzekering BES (BES Healthcare Insurance Claims Regulation). So insured persons do not have to pay the healthcare provider for this care. Additionally, the ZJCN manages the administration related thereto. The ZJCN makes contractual arrangements with healthcare providers, both individual practitioners and institutions, for this purpose. The ZJCN will not enter into a contract with any healthcare provider but it must contract sufficient healthcare providers to safeguard the accessibility of care for insured persons in the BES islands. For care which is not available in the BES islands, the ZJCN will make arrangements with healthcare providers outside the BES islands.
The ZJCN assesses whether all healthcare providers meet the statutory requirements regarding the qualification to practice their medical profession. Doctors, dentists, obstetricians and pharmacists must have a waiver as laid down in the Besluit uitoefenen medisch beroep BES (Practice of a Medical Profession Decree). It is the healthcare provider's responsibility to meet the statutory requirements for establishment. Failure to meet those requirements constitutes a ground to either terminate the healthcare contract or not to enter into the healthcare contract.
QUALITY & EFFECTIVENESS
In addition to the statutory requirements for establishment and for qualification of healthcare providers, we as the ZJCN strive to procure high quality and effective care services, keeping within the ZJCN budget which is set annually by the VWS. Therefore general quality requirements apply, which have been laid down in the ZJCN's General Procurement Terms and Conditions (in Dutch: Algemene Inkoopvoorwaarden). Additionally, specific quality requirements apply to individual healthcare providers. The ZJCN discusses these with the healthcare providers and they are laid down in the healthcare contracts between healthcare providers and the ZJCN. Important quality requirements imposed by the ZJCN on healthcare providers include, for instance, registration in a recognised quality register of healthcare providers, continuing and in-service training of the healthcare provider and accessibility and reachability of the healthcare provider's practice space. The ZJCN assesses new and contracted healthcare providers for the applicable quality indicators. This provides the ZJCN insight into the quality and effectiveness of the care provided. The ZJCN considers these insights during the procurement of healthcare, where selective procurement is not excluded. In case of selective healthcare procurement, we only enter into contracts with healthcare providers who meet our quality and effectiveness requirements.
If a healthcare provider offers care which is not included in the Regeling aanspraken zorgverzekering BES, the healthcare provider cannot claim payment for this care. If this care is provided regardless, the healthcare provider will cover the ensuing costs themselves. Furthermore, the ZJCN will not enter into a healthcare contract with any healthcare provider. As soon as an insured person intends to receive care from a non-contracted healthcare provider, he should ask the ZJCN for permission. If sufficient other healthcare providers are available who offer that same type of care and who have a contract with us based on indicators such as quality and effectiveness, the ZJCN will deny this request. If the insured person has received permission from the ZJCN, they can receive care from a non-contracted healthcare provider. In such a situation, instead of entitlement to the provision, the insured person is entitled to full or partial reimbursement of the costs incurred for this care. This is stipulated in Article 10.4 of the Besluit zorgverzekering BES.