The 2006 Dutch health insurance reforms introduced an alternative mechanism to settle disputes. This so-called “binding advice” is a binding third-party ruling to resolve disputes on the denial of coverage and the refusal to reimburse health services.
More than 12 years after it was introduced, the alternative dispute resolution (‘ADR’) regime gives reason for concern: legal criteria are interpreted differently by the ADR entity and the courts, thus causing inequalities in health care access under the Dutch Health Insurance Act. It is concluded that the privatisation of formal adjudication has largely frustrated citizens claiming access to medical technologies satisfying the ‘international medical science and practice’ test. It is therefore recommended that citizens opt out for the default option, challenging health insurance disputes in court.
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