Health insurers complicate public health

Meyken Houppermans, PhD. CrossFit Level 3 Trainer.
Founder and Head Coach
Dutch health insurers complicate Lifestyle Coaching, and therefore public health.

Fight for a healthier lifestyle

CrossFit Eudokia in Rotterdam is regularly approached by people who have been referred by their health insurer in a search for a professional and accredited Lifestyle Coach. Often, these people have already gone through a considerable process of guidance by all kinds of health professionals such as dieticians and Personal Trainers, without lasting results. Despite all the disappointments, frustrations and sometimes even despair, they have not given up the fight for a healthier lifestyle. We consider that very admirable.

Dutch health insurance companies advertise with the option of reimbursement for Lifestyle Coaching. There are two issues with this:

1. Lack of knowledge of Group Interventions versus Individual Coaching

Many health insurance companies seem to lack knowledge on the distinction between Group Interventions (in Dutch: Gecombineerde Leefstijl Interventie) en individual lifestyle coaching. Both are carried out by accredited lifestyle coaches. This accreditation is seen as prerequisite for reimbursement. Yet, most health insurance companies offer only reimbursement for group interventions. Individual coaching is not being reimbursed, regardless of accreditation of the lifestyle coach. Many health insurers are not aware of this and keep referring client to accredited lifestyle coaches regardless of whether costs are covered.

This "administrative distinction" is very confusing and dissapointing for clients and makes the search for a healthier lifestyle even more complicated. Sometimes people have already been through a group intervention program. Sometimes someone will benefit more from individual tailor made coaching.

2. Lack of acknowledgement of Individual Coaching

Research is being done on the effectiveness of Group Intervention programs. Their outcomes are relevant to decisions regarding reimbursement by health insurers, although those studies as well as their outcomes can be debated. For one, the studies are monitors on specific indicators, but do not address relevant topics regarding the effectiveness of programs such as mentioned below.

It seems the effectiveness of these programs is questionable. With the current programs, participants lose 3.5% of their weight after an average of 9 months. Group Intervention programs last 2 years. Half of the participants complete the program. In contrast, 26% stop in the first year. Of those who start the second year, about 35% still quit. Previous updates show that a lack of time and/or motivation was often the reason for quitting.

The impact on the prevalence of obesity is expected to be very limited. Experts find the results disappointing. An explanation for the low success of these programs is still unknown. Could it be that one size does not fit all? [1]

Because no research is done yet on the effectiveness of individual coaching by accredited lifestyle coaches, reimbursement is simply not in the picture.

Bureaucratism hinders healthy lifestyle

How can this case of bureaucratism be explained to someone who would love to improve their lifestyle and quality of life? Who wants to get healthy and fit again? People who would love to get rid of their obesity, exercise problems, excessive stress and sleeping problems? People who no longer want an increased risk of chronic lifestyle related diseases such as type 2 diabetes, obesity, cardiovascular disease, depression and cancer?

How can we explain that investing in a healthy  lifestyle is not reimbursed, but a gastric band, angioplasty surgery, diabetes treatments, very expensive medical procedures and medication are?  Sometimes these people are rightly desperate.

We sincerely hope that all parties involved realise this state of the art bureaucratism hinders public health. It is time to see what is really going on, what people really need and how easy it would be to provide the care people need. Because health professionals are there and ready to take on the task. The money needs to follow!

Create your own health!©


[1] Nederlands Tijdschrift voor Geneeskunde. (2021). De gecombineerde leefstijlinterventie. 2021;165:D5885.; GLI zorgt voor slechts 3,5 procent gewichtsverlies. Retrieved April 2024.; RIVM. Monitor Gecombineerde Leefstijl Interventie 2023.