Calculation of financial indicator and dimension scores Focus on Care Providers

Dutch Healthcare Authority (NZa)

Calculation of financial indicator and dimension scores for the Visibility of Care Providers dashboard

Last change on 10th of December 2025, at 13:11 (CET) | Publication Standard 1.0

• Publication category: Impactful algorithms
• Impact assessment: Privacy Quickscan
• Status: In use

General information

Theme

Health and Healthcare

Begin date

2020-12

Contact information

Wij werken aan toegankelijke en betaalbare zorg | Nederlandse Zorgautoriteit

Link to publication website

zichtopzorgaanbieders

Responsible use

Goal and impact

Purpose: To provide insight into the financial position of healthcare providers. This is done to support supervisory investigations.

Impact: The indicators and dimension scores on the Zicht op Zorgaanbieders dashboard are used by supervisors at both NZa and other target groups of the dashboard (IGJ, IKZ, insurers, municipalities, CIBG and DJI) to support their supervisory activities.

Considerations

Large numbers of healthcare providers have to submit annual accounts to the NZa, which imposes an administrative burden on them. The data from the Annual Accountability for Care are public, but the format in which these data are available does not lend itself to quickly gaining insight into a healthcare provider's financial position. By calculating the indicators and dimension scores on Focus on Healthcare Providers, it is possible to get a quick picture of a healthcare provider's financial position and any risks involved.

The scores do not in themselves signal problems or violations at a healthcare provider. The scores only serve to support existing signals or, in combination with other information, constitute a reason for further investigation.

Human intervention

The results of the algorithm per se have no direct impact. The supervisor only looks for healthcare providers on which more information is needed (e.g. in response to a signal) for supervisory work. The supervisor then interprets the indicators and dimension scores based on its own understanding and assesses for itself whether further investigation is needed.

Risk management

The risks in terms of technology, legislation, costs, ethics, explainability and other issues are very limited. The algorithm is not critical, no direct decisions follow from it and the technique is understandable and explainable.

Legal basis

Pursuant to Article 16 opening words and under a of the Wmg, the NZa's tasks include market supervision, market development and tariff and performance regulation in the field of healthcare. The ZoZ Dashboard is created and used pursuant to this statutory duty. Pursuant to Article 16(e) Wmg, the NZa is charged with supervising the performance by healthcare providers of the duties described in Articles 40a (keeping proper records) and 40b (timely disclosure of annual accounts) Wmg.

Pursuant to Section 32(1) Wmg, the NZa investigates competitive relationships and market behaviour in the field of healthcare. Article 32(2)(d) Wmg provides that this investigation may focus, among other things, on the performance of healthcare providers and health insurers, also with a view to comparing them. Article 33 Wmg provides that the NZa may make its findings public.

Elaboration on impact assessments

A legitimacy assessment has been done on the processes in which this algorithm plays a role according to our standard procedure. The impact on privacy of this algorithm is negligible.

Impact assessment

Privacy Quickscan

Operations

Data

To calculate the indicators and dimension scores, only data from the Annual Accountability for Care is used. To classify healthcare providers into a reference group, the legal form as recorded in the Chamber of Commerce trade register is used.

Links to data sources

• Regulation on public annual reporting Wmg: https://wetten.overheid.nl/BWBR0045649/2022-01-01/
• Chamber of Commerce trade register: https://www.kvk.nl/

Technical design

Two dimension scores (Spending of care money and Continuity) are calculated for each healthcare provider that has submitted an annual report. These dimension scores are each composed of a number of indicators. An indicator score is calculated for each indicator.

Calculation of indicator scores

1. The value of the indicator is calculated for each provider.

2. Each provider is assigned to one of three reference groups based on legal form: sole proprietorships, partnerships or legal entities.

3. Healthcare providers within a reference group are ranked using a cumulative distribution function (CDF).

4. For each indicator, a cut-off point is set. For some indicators this is a percentile score, for others the cut-off point is based on standards from the field.

5. The indicator score is calculated by subtracting the CDF of the limit value from the CDF of the indicator value and adding 1. For indicators where the limit value indicates an upper rather than a lower limit, the indicator value and limit value are first multiplied by -1 before the CDF is calculated.

Calculation of dimension scores:

1. For each provider, all indicators with a score lower than 1 (outside the limit value) are reversed (1 - score).

2. The reversed scores are added together.

3. Within the reference group, the percentile of the summed indicator scores is calculated. This percentile is the dimension score.

Missing data:

Sometimes data is missing, which means that not all indicators can be calculated. There are a number of indicators that are compulsory, because if the annual accounts are properly completed all data should be available to calculate these indicators. If a mandatory indicator is missing, an indicator score of 1 - CDF of the limit is assigned.