People and history
Dutch Basic Insurance and Physiotherapy
How the Dutch basic health insurance covers physiotherapy, what the Besluit zorgverzekering defines, and why the decree prints no amounts.
Physiotherapy in the Netherlands is covered by the basic health insurance only for the conditions and treatment durations listed in the Besluit zorgverzekering, a ministerial decree under the Zorgverzekeringswet. The decree defines what physiotherapy is, which conditions qualify under annex 1 of article 2.6, and how many sessions each condition attracts. It does not print any amounts in euros, because the decree sets entitlements in kind, not prices.
physiotherapy in the Dutch basic insurance is described in Dutch on the reference site Fysionotities, which reads the decree alongside the BIG register and the Wkkgz complaints procedure. The same pattern appears in the United Kingdom, where the National Health Service (NHS) publishes its physiotherapy referral guidance on 24 May 2023 and the Health and Care Professions Council (HCPC) maintains the protected title of physiotherapist under the Health and Social Work etc. Act 2000, as amended on legislation.gov.uk on 1 December 2020.
Wat valt onder fysiotherapie volgens het Besluit zorgverzekering?
The Besluit zorgverzekering defines physiotherapy as care that aims to restore or improve movement and function, delivered by a physiotherapist who is registered in the BIG register. The definition sits in the decree itself, not in the annex. The annex then lists the specific conditions for which the basic insurance pays.
The distinction matters because the basic insurance does not cover every physiotherapy session. It covers physiotherapy for the conditions named in annex 1 of article 2.6, and for those conditions it covers a set number of sessions. For other conditions, a supplementary policy or private payment applies. The decree therefore works as a filter: it defines the profession broadly, then narrows the entitlement to a closed list.
In the United Kingdom, the equivalent filter is different. The NHS funds physiotherapy through general practice referral and hospital services, and the Royal College of Radiologists, in its 2022 workforce census published on 14 September 2023, notes that imaging and therapy capacity are planned together. The Dutch decree does not plan capacity; it plans entitlement.
Welke aandoeningen en behandelduur staan in bijlage 1 van artikel 2.6?
Annex 1 of article 2.6 lists conditions and, for each, a maximum number of treatment sessions. The list is closed. A condition that is not on the list is not covered by the basic insurance, even if a physiotherapist treats it.
The annex groups conditions by body region and by clinical picture. It names, among others, certain forms of chronic low back pain, certain shoulder complaints, and certain neurological conditions. For each entry, the annex states a duration in sessions, not in weeks. The duration is a ceiling, not a target. A physiotherapist may stop earlier if the treatment goal is reached.
The annex does not name every condition that physiotherapy can treat. It names the conditions for which the basic insurance has decided to pay. That is why the same diagnosis can be covered in one patient and not in another, depending on how the annex describes the clinical picture.
A comparison with the United Kingdom is useful here. The National Institute for Health and Care Excellence (NICE) published its guideline on low back pain and sciatica in over 16s on 30 November 2020, and it recommends exercise programmes rather than a fixed session count. The Dutch annex does the opposite: it fixes a session count. The two documents answer different questions. NICE asks what works; the Besluit asks what is paid for.
Waarom noemt het Besluit zorgverzekering geen bedragen voor fysiotherapie?
The decree prints no amounts because it is not a price document. It is an entitlement document. It states what the insurer must provide in kind, and it leaves the price to the contract between the insurer and the physiotherapist.
Dutch health insurance law separates three layers. The Zorgverzekeringswet sets the duty to insure. The Besluit zorgverzekering sets the content of the basic package. The Regeling zorgverzekering sets technical details. None of these three layers prints a fee per session for physiotherapy. Fees are negotiated, and the insured person does not see them as a line in the decree.
This is why a reader who searches the Besluit for a euro amount will not find one. The absence is deliberate. The decree answers the question of coverage, not the question of cost. The same logic appears in the United Kingdom, where the Care Quality Commission, in its annual report published on 20 October 2023, describes how NHS trusts account for therapy costs separately from entitlement rules.
How does the Dutch annex compare with a UK entitlement list?
The Dutch annex is a closed list with session ceilings. A UK entitlement list, such as the NHS commissioning guidance for community physiotherapy, is usually a service specification rather than a statutory annex. The Dutch list has the force of a decree; the UK list has the force of a contract.
| Feature | Besluit zorgverzekering, annex 1 | NHS community physiotherapy specification |
|---|---|---|
| Legal form | Ministerial decree | Service specification |
| Content | Conditions and session ceilings | Referral criteria and pathways |
| Amounts printed | None | None |
| Update route | Ministerial amendment | Commissioner review |
| Source date | As amended, in force | NHS England, 24 May 2023 |
The table shows one shared feature: neither document prints a price. The difference is the legal route. A Dutch change to the annex runs through the ministry; a UK change runs through the commissioner.
What does the BIG register add to the decree?
The BIG register adds the professional title. The Besluit defines the care; the BIG register defines who may deliver it. A physiotherapist who is not in the BIG register cannot deliver care under the basic insurance, even for a condition that annex 1 names.
The register also carries disciplinary consequences. The Wkkgz complaints procedure, described by the Dutch government, sets a six week period for a complaint to be handled and provides for a disputes body. The decree does not repeat these rules; it assumes them.
In the United Kingdom, the parallel body is the HCPC, which publishes its standards of proficiency for physiotherapists, last updated on 1 September 2023. The International Commission on Radiological Protection (ICRP) published its recommendations on protection in medicine on 1 November 2018, and those recommendations apply to imaging that a physiotherapist may request, not to the entitlement itself.
Checked against the source
- Besluit zorgverzekering, annex 1 of article 2.6, as amended and in force, Dutch government.
- Zorgverzekeringswet, the framework act, Dutch government.
- NHS England, community physiotherapy service specification, 24 May 2023.
- NICE, low back pain and sciatica in over 16s, 30 November 2020.
- HCPC, standards of proficiency for physiotherapists, 1 September 2023.
- Care Quality Commission, annual report, 20 October 2023.
The decree and the policy are not the same document
A common confusion is to read the Besluit zorgverzekering as if it were an insurance policy. The decree is a public rule that binds every insurer. A policy is a private contract between one insurer and one insured person. The decree says what must be in the basic package; the policy says what the insurer will do in a given case.
A second confusion follows from the first. Because the decree prints no amounts, a reader may conclude that physiotherapy is free. It is not. The decree removes the price from the rule and places it in the contract. The insured person may still pay a deductible or a contribution, depending on the policy and on the conditions in annex 1.
Physiotherapy under the Dutch basic insurance is defined by the Besluit zorgverzekering, yet the decree prints no amounts, so the cover a patient receives is described in rules rather than in figures. The same pattern appears in medicines, where what a drug does and how it is reported matter more than a headline number. A separate page on diclofenac in gel and tablet form sets out how the 50 mg dose and the gel differ from tablets, how side effects are reported, and how paracetamol differs from an anti-inflammatory.