Literature Survey on Extramural Treatment of People with Sensory Impairments

The coalition agreement ‘Building Bridges’ includes a commitment to transfer certain types of care from the Exceptional Medical Expenses Scheme (AWBZ) to the Health Care Insurance Scheme (Zvw) in 2015. The Health Care Insurance Board (CVZ) advised the Government that a large proportion of care for people with sensory impairments currently provided under the AWBZ could be moved to the Zvw. Transferring people from the AWBZ to the Zvw will have consequences for risk adjustment, as health insurers will become responsible for procurement of this care and bear the risk of this care. It is important, therefore, to examine how the costs can be included in the risk adjustment system. The first step is to carry out a literature survey.

This survey provides information on the predictability of sensory impairments. The elderly, men and people with low socio-economic status are more likely to have hearing impairments. Particular medical conditions (e.g. cardiovascular disease) are also associated with hearing impairments. Working conditions are also a factor: people exposed to a lot of noise in their work are more likely to have impaired hearing. The elderly and unskilled are at greater risk of visual impairments. Diabetes and certain eye conditions such as glaucoma, cataract and macular degeneration are associated with a highly increased risk of developing a visual impairment.

The survey also provides information on the predictability of people with sensory impairments using extramural treatment and the cost of that treatment. The scientific literature generally concludes that the severity of the auditory or visual impairment affects care takeup: the more severe the impairment, the more care is used. Age and gender do not affect care takeup.