Abstract
Breast cancer is the most common cancer in women in the Netherlands, and breast reconstruction is becoming a common surgical procedure for women who have had a mastectomy. Reconstruction post breast cancer treatment is covered by conditional reimbursement until 01-04-2020 as long as it as an autologous fat transplant. Conditional reimbursements are special legal exceptions under constant consideration by the Ministry of Health and require evidence on treatment and cost effectiveness to be moved to basic healthcare package.
 Surgeons at Maastricht UMC+ have developed sophisticated techniques for women that undergo a reconstruction surgery to recover sensitivity of the breasts. Improved sensitization would lead to a better quality of life and protect the skin against thermal and mechanical injuries. However, current health insurance coverage of breast reconstruction does not permit these additions. Furthermore, the reimbursement system in The Netherlands does not allow people to pay an extra fee for these additions.
Highlights
1.1 Breast reconstruction surgery in the Netherlands Approximately 14,000 women are diagnosed with invasive breast cancer each year in the Netherlands, and about 1,900 have an in-situ carcinoma
The instrument conditional reimbursement can identify such health care and ensure the ‘managed introduction’ of interventions. [20,31] From the foregoing discussion on the reimbursement of a treatment under basic/supplementary healthcare insurance packages and the role of the actors in the healthcare system, it can be concluded that legally ‘conditional reimbursement’ is an exception in the Healthcare Insurance act which allows for a treatment to be included in the basic healthcare insurance content
4.1 Legal implications As a long-term solution to the prevalent situation, compel the lawmakers to consider evidence the on treatment and cost effectiveness since the introduction of the procedure. This could be the main evidence in support of moving the treatment from conditional reimbursement to the main basic insurance package
Summary
1.1 Breast reconstruction surgery in the Netherlands Approximately 14,000 women are diagnosed with invasive breast cancer each year in the Netherlands, and about 1,900 have an in-situ carcinoma. Cornelissen et al (2017) in a pilot study, concluded that "improved sensation in the autologous reconstructed breast, with the addition of microsurgical nerve coaptation, has a statistically significant positive impact on the quality of life in breast cancer survivors" [10] These conclusions support the premise that the importance of breast reconstructive surgery transcends the physical or aesthetical aspect of it. It is crucial for the patients' quality of life, which includes self-esteem, mental, psychological and sexual health. 2. Basic healthcare: provided pursuant to ZvW (Health Insurance Act). Basic healthcare: provided pursuant to ZvW (Health Insurance Act) This can be considered as the 2nd feature. The premium here can vary from €5-€50 and the basis for including a treatment under this package is to cover what is not covered by the basic healthcare insurance package. [14,15,17]
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