Assessment of 'established medical science and medical practice’ - a technical modification

This report is a supplement to the general assessment framework ‘Established medical science and medical practice’ dating from 2015. In this report, the Zorginstituut presents a framework that can be used for the questions whether an assessment might be necessary of a technical modification of an intervention already included in the insured package. If so, does this warrant concluding that the technical modification is also included in the insured package or is a separate assessment needed?

Dtuch assessment framework

The Netherlands introduced the Zorgverzekeringswet (Health Insurance Act) to provide health insurance with a broad package of care for all its citizens. An important key aspect is that care is only included in the insured standard health care benefit package if it is regarded as effective. The phrase used to describe this in the legislation is: the care must comply with ‘established medical science and medical practice’.

The Zorginstituut has established an assessment framework for its method for deciding whether care complies with the above-mentioned statutory criterion. This framework (recorded in the report ‘Established science and medical practice’ dated January 2015) is used for assessments carried out by the Zorginstituut in its capacity as manager of the standard package.