In incidental cases, GPs sell ANW services for a higher price than the maximum rates set by the Dutch Healthcare Authority (NZa). This is done both by commercial practices such as Co-Med and by GPs themselves.
Tim Linssen, general practitioner in South Limburg and member of the Advisory Board of Medisch Contact, knows that services are sometimes sold for a higher rate. ‘For example, if the GP has a sick child and has to get rid of a shift very quickly, or on a day that is very difficult to sell, such as a public holiday.’ GP emergency post West Brabant also has the impression that it sometimes happens, says board secretary Ingeborg van Beurden. ‘In the beginning after the introduction of the new schedule, there were at least two GPs who offered a higher rate than the NZa rate. We could see that from their advertisements in the roster system, which we approached them about. Since then we have not established this again. But I can certainly imagine that it sometimes still happens now, out of sight of us as a GP emergency room, especially if someone really has to leave their shift.’
Observers in the Brabant region sometimes receive higher rates from Co-Med, according to e-mails from Co-Med that Medisch Contact has seen. For example, she recently offered 200 euros per hour for a night shift from 10:45 p.m. to 8:00 a.m. for a service at the Eindhoven out-of-hours GP service. That comes down to 1850 euros per night, instead of 1220 euros per night. GP posts Oost-Brabant says in a response: ‘We are also hearing that services are paid above the maximum NZA rate. Although not legally prohibited, we have asked our GPs to do this as little as possible.’
Nevertheless, Linssen also says that he feels that the ‘trade’ in services has declined exponentially in his own region. It is also not the case that it is not legally allowed to offer a higher rate if a GP wants to sell a service. The LHV reports about this on its website: ‘The starting point is that no rates are paid on ‘the free market’ above the maximum rates set by the NZa. If it turns out that this cannot be achieved through the present plan, the government will investigate in the future whether this should be further regulated.’ When asked by the LHV, it appears that it does not know whether doctors offer even higher rates, but does intend to monitor this. However, the GP emergency centers must adhere to the maximum rates of the NZa.
As of 1 January, the NZa has increased and differentiated the rates for ANW services, and all general practitioners – practice owners and observers – receive the same fee for services. The rates are differentiated according to the time of the service, so a higher rate is paid for a public holiday and night shift (131.87 euros per hour) than for an evening (100.84 euros per hour) or a day shift at the weekend (116 .36 euros per hour). The GPs’ associations hope that this will put a stop to the price increase of services, and also that the unfavorable services, night shifts and public holidays, will be better filled.