Large health insurance companies have been able to force down fees for physiotherapists and speech therapists by so much that they are now much lower than the fees paid by small health insurers, the Volkskrant reports on Friday.

For example, market leaders Achmea and VGZ now pay up to 23% lower rates to speech therapists than smaller firms, the Volkskrant says.

‘If fees continue to fall, speech therapists will have little money left to live on. But if they accept such low fees, we will not be able to keep paying the higher rates,’ Chris Oomen, of small health insurer DSW, told the paper.

Free market

The difference in rates has never been so large since the free market was introduced for therapists rates in 2006. The lower fees should have an impact on health insurance premiums because insurers are not supposed to make a profit.

In terms of speech therapists, the big four – Achmea, VGZ, CZ and Menzis – now pay rates of between €29.22 and €29.80 for a 30 minute session.

After costs, this would give practitioners a pre-tax salary of €38,000, the Volkskrant calculates. The higher fees paid by small firms would give therapists a salary of €51,000 before tax and other wage-related deductions.

A spokesman for VGZ said it is up to individual therapists to decide whether or not to accept the fees.

Health insurers booked combined profits of €1.4bn last year, double their 2011 earnings while freezing or cutting premiums by a few euros.