The four big health insurance companies in the Netherlands are not doing enough to make sure their clients get good standards of care and have been told by the regulator to make improvements.

Zilveren Kruis, CZ, VGZ and Menzis are “not fully” meeting their obligations, the healthcare council NZA said after a year-long project to look at services in four regions with the longest waiting lists – Drenthe, Midden-Holland, West-Brabant and Twente.

Two of the four – Menzis and CZ – have now been given six months to make improvements and, if the watchdog is not satisfied, it will then be able to go public with its complaints. All four have now been told to make agreements with providers about reducing waiting lists so their clients can be treated in time.

“Access to care is no longer a given,” the NZA said in a press release. “This is a complex problem which everyone involved in the healthcare system is responsible for. Health insurers and healthcare providers must work together to ensure that people get the care they need.”

Health economist Xander Koolman told the Volkskrant the NZA’s decision is a “tough policy change” with potentially major consequences. “Insurers previously faced no consequences if they did not comply with their duty of care,” he said. “In effect, the government was saying focus on affordability, accessibility is of less importance.”

As a result, health insurers focused on cutting premiums which, he says, is understandable. But in effect, the NZA is now saying “enough is enough”, he told the paper.