In 2003 the Dutch Health Care Insurance Board (College van Zorgverzekeringen, CVZ) decided that cannabis would not be reimbursed as part of the universal health care coverage plan (‘basispakket’). The justification was that insufficient scientific proof exists to consider cannabis as ‘rational pharmacotherapy’. This means it is not yet clear enough how cannabis actually works, and more clinical evidence is needed to prove that cannabis is an effective medical treatment. Most Dutch health insurance companies still follow this advice.
The current situation in The Netherlands
A number of Dutch health insurance companies have reimbursed patients for their use of medical cannabis. However, they usually decide on a case-to-case basis, and the list of medical conditions that qualify for reimbursement is limited. Often, only part of the total cost is covered, and patients have to pay the remaining cost themselves. Because the exact conditions for reimbursement differ greatly between health insurance providers, patients are recommended to contact their own insurance company for more information.
In many cases, the procedure followed is this: The treating physician writes an official statement, indicating the specific medical condition of the patient, and the necessity to treat this condition with cannabis. The medical advisory board of the health insurance company then judges the case based on the medical history of the patient, and the seriousness of the medical condition. Besides an (in the Netherlands legally mandatory) basic health plan, a patient usually needs to be insured for additional costs (‘aanvullende verzekering’) in order to qualify for reimbursement. However, the extra cost of insurance is commonly much lower than the cost of reimbursed cannabis.
There may be many reasons to defend the reimbursement of medicinal cannabis use, either based on therapeutic value, public health, legal aspects, or even national health care costs.
There is mounting evidence for the medicinal effects of cannabis. An increasing number of clinical trials, performed in many countries and involving hundreds of patients, are showing the therapeutic value of cannabis for chronic and serious medical conditions. Compared to many standard drugs, cannabis is often shown to be a safe treatment; side-effects are relatively mild and do not cause permanent damage to health.
The insurance covers medicinal cannabis use only in a minority of cases. Because of their often poor financial situation, many patients are looking for the cheapest source of medicine. Because cannabis from a pharmacy may sometimes be more expensive than cannabis from illicit sources, many patients have chosen to use cannabis of unknown, and perhaps unsafe, quality. Although some contaminations (bacteria, pesticides) may not be directly harmful to a healthy individual, it should be an unacceptable risk for a seriously ill patient. Such contaminations may, for example, cause life-threatening pneumonia in an already immune-compromised AIDS patient. Reimbursement of high-quality medicinal cannabis from pharmacies may therefore indirectly reduce the total costs of the national health care system and can prevent a lot of individual suffering.