Pollution of water is not deemed material for a.s.r., but is material for a.s.r.'s subsidiaries a.s.r. health basic and a.s.r. health supplementary. For more information see section 6.1.2 and section 6.1.4.5.
Pollution of water is a major challenge in the health sector and consequently in the health insurance sector. Reducing water pollution is important to assure a continuing abundance of water that is safe to use for current and future generations. Health acknowledges the importance of this and wants to play a role in it. This section describes how Health has identified, measured and managed its negative impact on water pollution.
The following table presents an overview of the material impacts identified, along with the corresponding policies, actions and targets. The purpose of this table is to highlight the linkages and dependencies among these elements.
| Materiality | IRO Description | Product line, staff function and/or other | Policies | Actions | Targets |
|---|---|---|---|---|---|
| Negative impact | Health insurance offerings (facilitating access to healthcare services and medicines) indirectly lead to the pollution of water. Specifically in relation to the disposal and excretion of medication through urination and defecation which results in trace contaminants entering water systems. | 1. Health | 1. Procurement Policy of Health | 1. Stimulate healthcare providers to prevent impact. 2. Raise awareness among insured. 3. Make sustainability part of the preference policy for medication. | None |
6.2.2.1Managing impacts, risks and opportunities
Description of processes to identify and assess material pollution-related impacts, risks and opportunities
a.s.r.'s product lines and entities identified and assessed their impacts on pollution based on a set of predefined assessment criteria. See section 6.1.4.3 for more information about this process. This resulted in the identification of short-, medium- and long-term actual and potential impacts for Health. Health has not screened its site locations and business activities. No consultations have taken place with affected communities.
Health
When patients use medicines, drug residues end up in the surface water via the sewer. Locations where patients use medicines include healthcare institutions and patients' own homes, which together lead to a material impact on water pollution. As a health insurer, Health reimburses the medicines that patients use which cause the pollution of water.
6.2.2.2Policies and actions
Policies
Health
Agreements from the joint policy in the healthcare sector which follows the GDDZ 3.0 have been translated in to the Procurement Policy of Health. Consequently, policy objectives of the Procurement Policy of Health are:
Mitigating negative impacts by reducing medicine waste and excess medicine use; and
Substituting and minimising the use of substances of concern by including sustainability criteria in the purchasing of preferred medicines and (medicinal) products.
Key content of the Procurement Policy of Health is the expectation towards health care providers to commit to the GDDZ 3.0 and therefore to the policy objectives. Besides this, Health has a sustainability module in its Policy for pharmacy care which, among other things, encourages pharmacies to make agreements on demedicalisation and to reduce medicine waste.
In scope are healthcare providers, in particular pharmacists, hospitals and mental healthcare providers. The management team of Health is accountable for the implementation of the Policy.
Third-party standards that Health commits to respect through the implementation of the Procurement Policy of Health are the GDDZ 3.0 and the 'chain approach to pharmaceutical residues from water'.
Consideration was given to the interests of key stakeholders when setting the Procurement Policy of Health in alignment with the GDDZ 3.0 through reducing administrative burdens for healthcare providers. The current Procurement Policy has been published on 1 April 2024 and has been discussed during meetings with healthcare providers.
The policy focuses on both preventing impact (demedicalisation and preventing waste) as well as counteracting it (continued co-operation in ‘chain approach to pharmaceutical residues from water’). Measures in the ‘chain approach to pharmaceutical residues from water’ are aimed at replacing and limiting substances of concern in medicines as much as possible. Avoiding incidents and emergency situations is not specifically addressed in the policy.
The pollutants and substances covered by this policy are medicine residues as mentioned in the 'RIVM-briefrapport 2020-0088', for example residues of pain killers and antibiotics as well as blood pressure regulators, antidepressants, and anti-epileptic substances.
Key actions
Health
Joint key actions of health insurers, presented by expected outcomes, are:
Mitigate negative impact through healthcare procurement (policy) stimulating healthcare providers to prevent impact;
Mitigate negative impact and minimise the use of substances of concern by raising awareness among the insured;
Minimise the use of substances of concern by making sustainability part of the preference policy; criterion for purchasing medicines.
Actions relate to procurement policies and contracts of health insurers with healthcare providers, specifically pharmacists, and to (information about) sustainable choices that insured have regarding medication use.
Time horizons of the joint actions of health insurers are: 2025 for healthcare product (policy) stimulating healthcare providers to prevent impact and 2026 for the other two actions. Actions one and three regard upstream value chain engagements and action two regards downstream value chain engagements.
6.2.2.3Targets and metrics
Health
Health has not set any measurable outcome-oriented targets as these still need to be set up, and it does not yet track the effectiveness of its policies and actions in relation to its material sustainability-related impacts as this cannot be determined yet. No metrics are currently available on water pollution in the value chain.