Dutch hospital executives differ on patient access to non-reimbursed cancer drugs

When a new anti-cancer treatment reaches the market in the Netherlands, it is not always immediately covered by the country's publicly funded basic health insurance. That gap between regulatory approval and reimbursement leaves hospital executives facing difficult choices: whether to spend hospital budgets on treatments that insurers will not pay for, and whether to allow patients to cover the costs themselves. A qualitative interview study now shows how differently hospitals across the Netherlands handle this problem, and suggests that the answers may shape which patients can actually receive newly approved cancer therapies.

According to the study, published in BMC Health Services Research, the authors state that no empirical research on in-hospital policies regarding non-reimbursed treatments had previously been conducted in countries with publicly funded healthcare systems, making this one of the first systematic looks at how such institutions navigate the reimbursement gap. The interviews revealed considerable variation. In some hospitals, treatments were occasionally paid for using hospital budgets, while in others this did not occur at all.

In general hospitals, patients whose relevant treatments were not yet reimbursed were often referred to academic hospitals, effectively shifting the access question to another part of the system. Underlying these practical differences, respondents expressed broad concern about the rising costs of newly approved anti-cancer treatments and about healthcare costs in general. Views on out-of-pocket payments, in which patients pay for non-reimbursed treatments themselves, differed among respondents.

The study's central conclusion is that practices, policies and executives' perspectives vary among Dutch hospitals, and that this variation might lead to differences in access to non-reimbursed anti-cancer treatments among Dutch patients. Because the study is qualitative and based on interviews with executives at 17 institutions, it maps the landscape of practices and moral perspectives rather than measuring how often patients ultimately receive non-reimbursed treatments, or how large the resulting differences in access are. The findings arrive as expensive new anti-cancer treatments continue to enter the market ahead of reimbursement decisions, keeping the question of who pays, and on what moral grounds, firmly on the agenda of hospital boards.

The study suggests that in the Netherlands, those answers currently depend on where a patient is treated, and that hospital executives themselves recognize the tension between case-by-case flexibility and the egalitarian principle that access to care should not depend on hospital policy or personal means.

Subject of Research: Health services research on access to non-reimbursed anti-cancer treatments in the Netherlands

Article Title: Access to non-reimbursed anti-cancer treatments: an interview study on in-hospital practices and policies and moral perspectives of hospital executives in the Netherlands

Article References: Bomhof, C. H. C., Smids, J., & Bunnik, E. M. (2026). Access to non-reimbursed anti-cancer treatments: an interview study on in-hospital practices and policies and moral perspectives of hospital executives in the Netherlands. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15941-w

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15941-w

Keywords: cancer treatment, health insurance, reimbursement, hospital policy, Netherlands, healthcare ethics, qualitative research, health equity, out-of-pocket payments, Access, non-reimbursed, anti-cancer