"The Health Insurance Office is aware that the implementation of the healthcare legislation is still not optimal.
Together with my workers I am doing everything to improve the services and where possible to optimize the processes", says the Head of the Health Insurance Office (ZVK) Jan Pieter van Zandwijk. "I realize that there is unrest among the insured regarding the implementation of the health care legislation. There are many questions about medical referrals, the related accompaniment and payment of daily allowance".
What will be improved?
"We are busy working to remove the backlogs. At this moment there is a backlog in the payment of declarations for the insured. We expect that we will be able to remove all backlogs in payments by the end of July".
The telephone accessibility is improved and within very short an additional worker will be employed for the telephone team. There is special attention for improving the communication with general practitioners.
We take complaints very seriously and have employed a special complaints officer. A reply will be provided to complaints submitted in writing within 6 weeks.
By implementing an automated system we will be able to streamline the processes better. In September we will start with the computerization of all processes. The complete automated system, which will be introduced in phases, will take a year."
Procedure medical referrals
There appear to still be some lack of clarity regarding the procedure surrounding medicals referrals. "The general practitioner advises that a patient must be treated abroad. This advice goes to the Health Insurance Office. Since the beginning of June a committee of doctors of Foudashon Maria Daal is advising regarding there medical importance of this. The Health Insurance Office is the one who ultimately decides. When there is a positive decision the Health Insurance Office makes arrangement for a hotel and a ticket and the payments of the daily allowance is regulated via the bank. This administrative process requires 14 days. For emergency referrals no permission is required from the Health Insurance Office.
To clarify the possibilities for accompaniment with medicals referrals, the Health Insurance Office is currently in discussion with general practitioners. Together a concept protocol for this is being drafted wherein is clearly described which patients and what accompaniment is required. Minor children are always entitled to accompaniment"
Compensation for medicines
There are many questions regarding the compensation for medicines. "Via the Health Insurance Office only generic medicines will be compensated. These are medicines which have the same substances and effects as branded medicine. When a patient specifically wants to use branded medicine he will need to pay this himself.
The Health Insurance Office has signed contracts with almost 100 care providers. There are a total of approximately 21.000 insured on Saba, St. Eustatius and Bonaire. The total budget for the enforcement of the health care legislation for 2011 is 60 million dollar. This figure includes the implementation costs.
Information regarding the Health Insurance Office is available on www.rijksdienstcn.com under the heading health care. Within short a new door to door information booklet about health insurance will be circulated.