The Netherlands’ largest health insurer, Zilveren Kruis, is cutting fees for family doctors who refuse to offer online triage apps to their patients, even though the body set up to evaluate such tools says more evidence of their effectiveness is needed before they should be scaled up, broadcaster NOS reported.
Practices that opt out face a €1 cut in reimbursement per patient a year, NOS said after examining Zilveren Kruis’s tariff schedule and speaking to dozens of family doctors. For a typical list of 3,600 patients that runs into the thousands of euros, and at the largest practices the loss can reach €10,000.
The apps include moetiknaardedokter.nl (MINDD), which in April was found to have been giving medical advice for around five years without the right certification and appeared to sidestep stricter EU rules on medical advice software.
€800 million
A February report by Digizo.nu, set up by the 14 sector organisations behind the country’s two main healthcare agreements, concluded that the evidence base for triage apps is too weak to draw firm conclusions about their value. Patient take-up is around 3%, and the evidence on effectiveness, safety and waiting times was rated “very low”.
Despite this, €800 million in public money has recently been committed to scaling up digital health tools, including these apps, over the next three years. Long-term care minister Mirjam Sterk defended the spending: “We have to look for smart solutions, and digital triage is one example,” she told NOS.
Sterk declined to comment on whether critical doctors should be financially penalised, saying agreements between insurers and providers were not her remit. The national family doctors’ association LHV, which co-signed the healthcare agreements, said it could see a role for the apps but that this was “currently not sufficiently safeguarded”.
“Backs against the wall”
Niels Chavannes, professor of family medicine at Leiden University Medical Centre, told NOS that GP practices “have their backs against the wall”. Tariffs set by the healthcare regulator NZa have been ruled structurally too low since 2023, leaving practices little financial room to refuse the fee cut.
For Utrecht GP Nanja Danhof, whose Kanaleneiland practice has more than 9,000 patients, the safety risk outweighed the financial one. Many of her patients have limited Dutch or know little about the healthcare system, she said, and could easily fill in the app incorrectly without her seeing the result.
Danhof said her practice did briefly consider adopting the app because of the financial loss. “That shows how financial pressure limits our freedom to make medically responsible choices,” she told NOS.
