Please note: The algorithm descriptions in English have been automatically translated. Errors may have been introduced in this process. For the original descriptions, go to the Dutch version of the Algorithm Register.
Cost prices and maximum rates msz
- Publication category
- Other algorithms
- Impact assessment
- Privacy Quickscan
- Status
- In use
General information
Theme
Begin date
Contact information
Responsible use
Goal and impact
These cost-price studies only concern medical-specialist care for which the NZa sets maximum rates: the so-called A-segment. This is only a small part of medical-specialist care. It includes, for example, oral surgery, 'other care products' and vaccination packages. The vast majority of medical-specialist care treatments have freely negotiable rates between hospitals and health insurers: we call this the B-segment.
The NZa sets maximum rates to ensure that the rates cover the costs of treatments, but are also not unnecessarily high. The aim of this is to keep healthcare, which we jointly finance through taxes and healthcare premiums, affordable for those who need it.
Considerations
Certain institutions are exempt from submitting cost data. These are:
Institutions providing only a small share (less than 10%) of care in the regulated segment are exempt from the provision of cost price data. However, we also examine whether there are institutions below this limit that specialise in providing certain regulated care, and are therefore still relevant for the cost price survey, so that reliable rates can be calculated. Therefore, in addition to the share of regulated vs free segment, we also look at provider shares within a healthcare product from the regulated segment.
As a first step in the process, policy officers assess the institutions' submissions. A checklist is available for this purpose.
The calculation of the weighted average cost prices per product is accompanied by an assessment of the validity of the cost prices. This is done in a number of steps, starting with assessing a healthcare product on the basis of the complete delivery in terms of the ratio between average cost price and rate (KO ratio) and the spread of the deliveries (CV value). In case of deviating KO-ratio and/or CV-value, an explanation is sought for this deviation in the delivered cost prices, e.g. whether this is possibly due to the calculation method, a change in the care input, or a change compared to the historical cost price data. Based on the possible explanations, it is then decided whether individual submissions can be approved or cleaned, or whether more information is required from the provider for further assessment.
Human intervention
An institution will be contacted if consideration is being given to completely excluding an institution from the costing calculations. Institutions are then given the opportunity to adjust their cost prices or make a completely new submission if necessary.
If there is then any doubt about whether or not to include the cost price of a product, the institution will be contacted by e-mail.
In addition, all institutions receive institution-specific feedback. This also includes an Excel file containing an overview per cost price, including the validity assessment.
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
The following policy rule and further rule relate to the submission of cost prices:
-Policy rule Cost model care products medical-specialist care (BR/REG-23152)
-Regulation on registration and submission of cost prices of medical-specialist care products (NR/REG-2320)
Links to legal bases
- NR/REG-2320: https://puc.overheid.nl/nza/doc/PUC_739805_22/
- BR/REG-23152: https://puc.overheid.nl/nza/doc/PUC_739810_22/
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
Operations
Data
It concerns cost price data of (other) care products supplied by MSF institutions.
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