Nine out of 10 family doctors are unhappy with the contract they have signed with health insurance companies, according to a survey by national association LHV and quoted by current affairs programme Nieuwsuur.

In particular, doctors are unhappy that the association is not allowed to negotiate on their behalf because it would break anti-cartel legislation. Doctors are supposed to compete with each other to ensure the Dutch health system operates as a proper market.

But doctors say this leaves them powerless to negotiate with insurance companies. Four companies control 90% of the market.

Doctor Vincent Coenen told Nieuwsuur he had no choice but to sign. ‘It was a question of sign where indicated or not,’ he said. ‘We decided we had to sign because if we had not done, we would not have been able to offer our patients some treatments.’

Health minister Edith Schippers says she recognises doctors are at a disadvantage in the negotiations and is setting up a complaints panel.

Financial incentives

Doctors are also angry that health insurers are trying to steer the type of drugs they prescribe and ensure patients are referred to labs they have contracts with for tests by offering financial incentives.

There are almost 9,000 family doctors in the Netherlands, who are responsible for solving 94% of patients’ complaints. They do this on 5% of the total healthcare budget.

‘Family doctors have to be independent and patients have to trust they are working in their interests without having a financial interest,’ Coenen said.