Health insurer Zilveren Kruis is exerting financial pressure on house doctors to use triage apps that do not comply with laws and regulations, dozens of general practitioners (GPs) told NOS after it reported on the unreliability of these healthcare apps.

The apps involved advise patients on whether they should make an appointment with the doctor or wait and see how their symptoms develop. GPs told NOS that they have doubts about whether the apps are medically sound, but if they refuse to use them, they are financially penalized because Zilveren Kruis gives them lower reimbursement for other care.

According to the broadcaster, the current situation is partly the result of two major healthcare agreements from 2022 and 2024, in which the healthcare sector, health insurers, and the Cabinet pledged to keep healthcare accessible and address staff shortages. Healthcare apps that reduce the workload, including triage apps, are a priority in the agreement.

A recent report by the knowledge platform Digizo.nu, established by the parties that signed the above healthcare agreements to advise the sector on digitalization, shows that there is still uncertainty about how effective these triage apps are. The platform advised more research before rolling out the apps on a large scale.

Despite these doubts, Zilveren Kruis, the largest health insurer in the Netherlands, started putting pressure on GPs to use the apps this year. Practices without a triage app receive €1 less reimbursement per patient, NOS discovered in the health insurer’s rate list.

On average, GP practices have over 3,600 patients, so the potential loss runs into the thousands of euros. The health insurer told NOS that this financial incentive is intended to help make healthcare more efficient and thereby keep it accessible. It added that the measure stems from the healthcare agreements that the National Association of General Practitioners (LHV) also signed.

Utrecht GP Nanja Danhof has over 9,000 patients, but could not in good conscience start using the app despite the financial blow, she told NOS. “Many of my patients do not speak Dutch well or have little knowledge about healthcare, which means there is a high chance they will fill out these apps incorrectly. That can become dangerous, because patients might receive incorrect advice, and I have no oversight on that,” the house doctor said. “Naturally, due to the financial loss, we briefly considered using the app. This shows how financial pressure limits our freedom to make medically responsible choices.”

Niels Chavennes, a professor of General Practice at the Leiden University Medical Center, told NOS that health insurers and the government need to take more responsibility within this major healthcare reform. “General practitioners are being backed into a corner. It is difficult to keep the practice running because funding is already too tight. This way, you will be forced to choose apps that have not yet proven themselves, and you do not support.”

Minister Mirjam Sterk of Long-Term Care told NOS that the fact that the apps do not yet comply with the rules or may pose risks is a secondary issue. “There is a looming shortage of general practitioners. We must look for smart solutions, and that is, for example, digital triage.” She stressed that she takes the signals from GPs seriously, but would not comment on critical doctors being undercut by health insurers. “I do not decide on agreements between health insurers and healthcare providers.”