Direct Request (CEACR) - adopted 2013, published 103rd ILC session (2014)

Medical Care and Sickness Benefits Convention, 1969 (No. 130) - Netherlands (Ratification: 2006)

With reference to its observation, the Committee notes the Government’s report on Conventions Nos 102, 128 and 130 containing its reply to the direct request of 2012 concerning Convention No. 130, as well as the observations made in this respect by the Netherlands Trade Union Confederation (FNV) dated 30 August and 16 September 2013.

Part II (Medical care) of the report form and Article 13(a) of the Convention. Domiciliary visiting. In reply to the Committee’s previous comments, the Government states that domiciliary visits are covered by the basic insurance coverage, but a general practitioner is not obliged to perform such visits at the request of the insured person unless he or she deems it necessary due to the severity of the condition and the health-care history of the patient. The Committee recalls that the content and scale of medical benefits included in the basic insurance package under the Health Insurance Act are regulated by the Health Insurance Decree and the Health Insurance Ministerial Order. The Committee would like the Government to specify the provisions in these or any other relevant texts which expressly refer to domiciliary visiting by general practitioners, as required by Article 13(a) of the Convention.

Article 13(e). Dental care for adults. The report confirms that dental care for insured persons over 18 years is limited to specialized surgical dentistry (oral surgery), the associated X-rays and dentures, and therefore excludes essential dental care usually provided by dentists, such as preventive advice, check-ups, fillings, root canal treatment, extractions, dental supplies, etc. The FNV observes that most Dutch adults have to pay for dental care out of pocket or buy additional private dental insurance. As a result, the Dutch health-care system does not comply with the Convention. The Committee points out that dental care mentioned in Article 13(e) of the Convention forms part of medical care defined in Articles 8 and 9 in the form of care of a curative and preventive nature afforded with a view to maintaining, restoring or improving the health of the person protected. This definition is obviously much larger than oral surgery covered by the Health Insurance Act and would normally include, as in other European countries, the essential dental care mentioned above. The Committee would like the Government to explain the reasons for leaving the essential dental care outside the basic health insurance coverage and the accessibility of the additional private dental care insurance to persons of small means protected by the Convention.

Effectiveness of medical care. In its previous comments, the Committee noted that the Dutch Government limited its role in overseeing the health insurance to ascertaining whether the private insurer is fulfilling its obligation to provide insured persons with the services they are entitled to under the Health Insurance Act; it consequently pointed out that such limited supervision of the quality and effectiveness of the medical care provided by private insurers seeking to make a profit, and therefore interested in reducing the volume and cost of care, may pose a threat to fulfilling the obligation imposed on the Government by Article 9 of the Convention to ensure that the medical care conforms to the highest practicable standard with a view to maintaining, restoring or improving the health of the person protected. The Committee therefore asked the Government to explain whether the Health Care Inspectorate (IGZ), which is entrusted with overseeing the quality of public health, or any other public body has established a system of indicators measuring effectiveness of medical care and monitoring the health status of the population.

In reply, the Government states that since 2007 the project “Zichtbare Zorg” (Visible Care) was set up to develop indicators to measure the quality of health-care provision. Since 1 January 2013, it has been absorbed by the newly established Dutch Quality Institute. The Government further states that the Dutch health-care system uses indicators to measure the quality of the health care provided, but emphasizes that the basic assumption is that patients, health insurers and health-care providers are best placed to determine good, quality health care and therefore make agreements on quality standards. The Committee understands from this statement that in order to determine the quality standards of medical care provided for the population the Government relies on supply and demand outcomes and would like the Government to explain the respective roles played in this process by the Dutch Quality Institute and the Health Care Inspectorate. In order to demonstrate that the Dutch health-care system has not lost its effectiveness after privatization in 2006, the Committee would like the Government to show in its next report, on the basis of the available health statistics and quality indicators for the period 2006–13, that the health status of the Dutch population has been improving.

Part III (Sickness benefit). The report indicates that the conditions for entitlement to sickness benefit after the first year of illness have been made stricter through amendment of the Sickness Benefits Act (ZW) by the new Act limiting sick leave and incapacity entitlement for those covered by safety net provisions, which entered into force on 1 January 2013. Firstly, the existing criterion of the ability to perform “his/her work” (the work performed most recently) was replaced by the criterion applied under the legislation on incapacity for work (WIA), and the ability to perform “generally accepted work”. The FNV observes that this change results in an unacceptable deterioration of protection for workers with temporary employment contracts compared to workers with permanent contracts, creating two types of workers with unequal entitlements to cash benefits in case of sickness. Secondly, similarly to the WIA, entitlement to sickness benefit was divided into two parts: a wage-related benefit and a minimum benefit. The period during which the wage-related benefit is paid will depend on a person’s employment record. However, the introduction of an employment record requirement has been legally postponed to 1 January 2014, while an alternative solution is being sought under the Coalition Agreement. The FNV adds that legislation for withdrawing this requirement is being prepared. Thirdly, the FNV observes that the Government’s report failed to mention the introduction, similarly to the WIA, of the 35 per cent threshold of loss of earnings for eligibility to sickness benefit after one year of illness. Henceforth, those workers who because of illness have lost less than 35 per cent of their earnings are simply no longer considered sick. The FNV finds all of the above three new conditions for entitlement to sickness benefit contrary to the Convention. Recalling that sickness benefit in the Netherlands is payable for a maximum of two years (104 weeks), the Committee notes that the said conditions are introduced after the first year of illness with respect to entitlement to sickness benefit for the second year. The Committee observes that transposing the requirements contained in the WIA with respect to the disability benefit on the sickness benefit changes the nature of the latter so that in its second year of payment it resembles more a disability benefit than a sickness benefit and thus falls outside the scope of the Convention. The Committee recalls, in this respect, that Article 26(1) of this Convention allows for a limitation of the sickness benefit to 52 weeks in each case of incapacity. The Committee asks the Government to confirm that stricter conditions for entitlement and stricter obligations placed on recipients to return to work introduced by the abovementioned Act do not concern the granting of the sickness benefit during the first 52 weeks of incapacity.