Demande directe (CEACR) - adoptée 1993, publiée 80ème session CIT (1993)

1. Part II (Medical care), Article 10, paragraphs 1(b) and 2(b), and Part VIII (Maternity benefit), Article 49, paragraph 2, of the Convention. In reply to the Committee's previous comments, the Government indicates that the question of the elimination of the direct participation by beneficiaries in the cost of medical care in the event of pregnancy and confinement and their consequences is currently the subject of an in-depth examination in the framework of the progressive process of the transformation of the various health insurance schemes in the Netherlands into a general compulsory scheme which will be extended to all residents. The elimination of personal contributions to the cost of medical care in the event of confinement will be strongly encouraged, particularly when the above care is provided in hospital upon medical advice. This question is also the subject of continued political debate. The Committee notes this information. It once again hopes that, in the context of the health insurance reform, the necessary measures will be adopted to eliminate personal contributions by beneficiaries to the cost of medical care during confinement, when this care is provided upon medical advice, in a hospital or special maternity centre, in accordance with the above provisions of the Convention which, with the exception of pharmaceutical supplies, does not authorize such contributions in cases of pregnancy and confinement and their consequences.

2. In its report, the Government supplies new information concerning the reform of health insurance, of which the second stage commenced on 1 January 1992. It indicates in particular that a number of benefits, including the provision of pharmaceutical products, are now covered by the Exceptional Medical Expenses Act. It will be for the persons covered by this Act to decide whether to pay a part of the costs of health care themselves (up to a certain amount) during the procedure of reimbursement or payment by a third party in order to decrease the nominal amount of the contribution. The Committee notes this information. It also notes the summary provided by the Government in the context of its 25th report on the application of the European Code of Social Security as amended by its Protocol, which indicates the care and services to which beneficiaries are entitled under the Exceptional Medical Expenses Act, as set out in the regulations adopted under section 6 of the above Act, as well as a summary of the Regulations on pharmaceutical assistance. According to these regulations, insured persons are offered a package of qualitatively good medicines without having to make any supplementary payment; however, medicines are not included in this package if there exists another pharmaceutical speciality of good quality at a lower price. The Committee requests the Government to continue supplying detailed information on the implementation of this reform, particularly in the light of the relevant provisions of Parts II, VI, VIII and XIII of the Convention, and to supply the text of any relevant new legislation or regulations.

The Committee reserves the possibility of examining in greater detail the text of the decree on the services provided for under the Exceptional Medical Expenses Act, and the Regulation on pharmaceutical assistance of 23 December 1991, as soon as it has at its disposal the translation which is currently being made of these texts.