The so-called paramedical recovery care for patients with long-term complaints after COVID-19 (post-COVID) will disappear from the basic package of health insurance as of 1 July 2024. The Dutch Healthcare Institute (ZIN) has concluded after research that the combination of therapies is not demonstrably effective enough for this group of patients. The Ministry of Health, Welfare and Sport has promised a transitional arrangement until the end of 2024. This will allow everyone who is currently receiving this recovery care to complete their treatment.
Conditional admission
A large group of patients had long-term complaints after a COVID-19 infection, for which there was (and is) no treatment available. At the time, the Ministry of Health, Welfare and Sport asked the Dutch Healthcare Institute for advice on the options available to provide the right paramedical (after)care in the right place to these patients. First-line multidisciplinary paramedical recovery care after COVID-19 was seen by parties in 2020 as the best option that could contribute to recovery, but knowledge about this was limited.
Only care that really works may be included in the basic health insurance package. As long as this evidence is not available, the Minister of Health, Welfare and Sport (VWS) can decide to temporarily reimburse the care from the basic package. The only way to reimburse this care from the Health Insurance Act (Zvw) was through the 'conditional admission' scheme. This allowed the Minister of VWS to temporarily admit this care to the basic package, on the condition that scientific research is conducted into the effectiveness of this care. In this way, research was conducted into whether this care is actually effective and could be permanently reimbursed from the basic package.
The Minister has decided to conditionally admit primary multidisciplinary paramedical recovery care for persistent complaints and limitations after COVID-18 to the basic package as of 2020 July 19. The conditional admission initially ran until 1 August 2021 but has been extended several times until 1 January 2025.
Research
An observational study, a study without a comparison group, was started by the Healthcare Institute as soon as possible. In order to assess whether care is sufficiently proven effective, a literature study was first conducted. This search did not yield any relevant studies to answer the question whether first-line multidisciplinary paramedical recovery care for persistent complaints and limitations is effective compared to no treatment.
The VT study on primary multidisciplinary paramedical recovery care (ParaCOV study) became available and shows positive changes in participation, quality of life, fatigue and physical functioning in post-COVID patients. However, based on this study it could not be concluded that these positive changes were the result of the intervention.
It was therefore decided, partly on the advice of the Scientific Advisory Board (WAR), to wait for the comparative study in which the patients who participated in the VT study were compared with patients without this care. The comparative study shows that patients who do not receive paramedical recovery care improve to approximately the same extent in the areas of physical functioning, quality of life, participation and fatigue. This makes it very uncertain whether the improvements found in the VT study are the result of the first-line multidisciplinary paramedical recovery care or of the natural course of the condition.
Conclusion
The Dutch Healthcare Institute therefore concludes that the added value of the treatments has not been demonstrated, which means that these treatments cannot be reimbursed from the basic health insurance package.
Promising care
The Netherlands Healthcare Institute encourages further research into the effectiveness of possible treatments for patients with post-COVID and is involved in the design of specific post-COVID outpatient clinics in combination with scientific research in order to arrive at appropriate treatment for post-COVID patients.
Transitional arrangement Ministry of Health, Welfare and Sport
- Within the transitional arrangement, patients who are currently receiving paramedical treatment can also complete it. Based on this transitional arrangement, patients who started a treatment trajectory in the first or second term before 1 July 2024 can complete their term.
- The treatment courses last a maximum of 6 months and the transitional arrangement therefore runs until the end of this year.
- It is not possible to start a first or any second term after July 1, 2024.
- Monodisciplinary paramedical care, as it is now included in the basic package, can continue to be reimbursed unchanged. To be precise, this is 3 hours of dietetics, 10 hours of occupational therapy and speech therapy without a maximum per year.
- Physiotherapy and exercise therapy are no longer included in the basic package and can only be reimbursed in specific situations from the 21st treatment. Supplementary insurance can offer a solution here.
For more information about the Healthcare Institute's research, click on the link below.
