What is so special about the Netherlands?
The Netherlands were the first European Member State to implement a centralised register of financial relationships between healthcare professionals and the pharmaceutical industry back in 2013 and their work has paved the way for the rest of Europe. Back in 2009, the Minister of Health, Ab Klink, was inspired by the US initiative that led to the Sunshine Act and wanted to set up a similar system in the Netherlands. Rather than being enshrined in law, this would be a self-regulatory code, he announced in a speech to mark the 10th anniversary of the De Stichting Code Geneesmiddelenreclame (CGR), the organisation responsible for overseeing the code of practice for pharmaceutical advertising in the Netherlands.
How did they do it?
According to Michel A. Dutrée, general manager of Nefarma (the association for innovative medicines in the Netherlands), the process was facilitated by the good collaborative relationships between all involved: he claims “We had more than 15 years of multi-stakeholder engagement and this was the key to the whole process.” The Royal Dutch Medical Association, representing healthcare organisations, already had a working system called Gaia, supporting its professional accreditation system. “The Association pointed out that doctors were already familiar with Gaia, and suggested the financial disclosure register could be implemented on it,” according to Dutrée. The Ministry of Health agreed with the suggestion, and also agreed to pay start-up costs, with the CGR and Nefarma member companies paying for the maintenance of the register.
About the Transparency Register
The Transparency Register Foundation (Stichting Transparantieregister Zorg) is an independent organisation established in 2012 by the CGR. There is a vision that in the future the Foundation will manage and publish financial relationships from other branches and occupational groups: for example financial relationships between veterinarians and veterinary pharmaceutical companies.
The CGR Rules of Conduct include the obligation to doctors, pharmacists, nurses and pharmaceutical companies to report data on service, consultancy and sponsorship relationships to the register. Pharmaceutical companies must report their financial relationships with healthcare workers in the Netherlands; however, if there is a financial relationship with a pharmaceutical company abroad, the obligation to report the register lies with the physician, healthcare provider or institution.
What does information does the central database contain?
So far, the central data holds published payment data for 2013 and 2014. The ‘Healthcare Transparency Register’ includes the name of the professional; professional association (scientific society, partnership, etc.) or institution; company name; the nature of the financial relationship (consultancy, advisory board, speaker, research, sponsorship or other) and the total amount or fees paid in that year. Payments that do not exceed €500 for the year do not need to be published on the register. Disclosure for the register must be carried out once a year and within three months after the previous calendar year and the data is removed after being held for three years.
Michel A. Dutrée, general manager of Nefarma, has previously given the following advice to countries wanting to establish a central payment database:
- Team up with doctors and other healthcare professionals early on in the process;
- Do not under-estimate the amount of work you – as an association – need to do. All the information must be thoroughly checked, and all member companies must be aligned to ensure data inputs are consistent;
- See if it is possible to piggy-back an existing ICT platform that is already used by doctors – adding additional functions is easier than setting up a new platform;
Over time there has been a change in the reaction to the Dutch database. On the day of the launch there were 33,000 hits on the website, now there are only around 600 per week. According to Dutrée, there was a lot of press coverage at the time but the great majority was positive: “Everyone was curious, but soon the novelty was gone. When we published the second edition in April 2014, there was only one newspaper article…”
Will the reaction to the release of individual payment data in other European countries also fizzle out in the same way? Only time will tell.
Ruth Knowles is a freelance science writer who has written articles and press releases on a range of life science and health topics. She received her MSc in Science Communication from the University of the West of England, Bristol.