By Rene Zwart

The Hague – The Caribbean Netherlands Healthcare Insurance Agency (ZVK) cannot prove the ‘legality’ of tens of millions that it has spent providing healthcare to the inhabitants on the three BES-islands. This is noted by the Dutch Audit Chamber, which examined the expenditures of ZVK in the context of the presented financial statements.

In 2016, the Ministry of Health, Welfare and Sport spent a total of 107.8 million euros for care for residents of Bonaire, Sint Eustatius and Saba. The auditor, despite an additional audit, was unable to assess whether a total amount of approximately 58.5 million was correctly spent.

Since 2013, the Audit Chamber has established that legitimacy of considerable part of ZVK’s expenditures cannot be (sufficiently) determined. Inadequate internal organization at the various healthcare providers is an important cause for the findings.
The Audit Chamber urges the ZVK to ensure good contractual agreements with providers and to keep monitoring developments. “Currently there is a lack of clarity about the performance of providers and the achievement of quality objectives to be achieved by the care providers, as well as clarity about the applicable prices and advances paid by the ZVK. As a result, there is a risk that healthcare expenditures may not be legal and healthcare expenditure may also be incorrectly declared and/or reimbursed”, according to the Audit Chamber’s report.

Nevertheless, the auditors still see reason for optimism. Last year in May, after a delay of some years, a healthcare contract was signed with Mariadal, the largest healthcare provider of the BES. “The head of the ZVK expects that the regularity of health care expenditure at this care provider can be determined by 2018 at the latest. This is an important prerequisite for an unqualified auditor’s report on the regularity of the Health Insurance Accountability Statement 2018 itself, ” according to the Chamber.