Paying for psychological well being care within the Netherlands – Healthcare Economist


As COVID-19 has made many people acutely conscious, offering prime quality psychological well being care is significant. Nevertheless, the psychological well being care market is a troublesome one for insurers; there’s proof that uncertainty and variation in remedies are larger in comparison with bodily well being situations (as an illustration, see Frank et al. 2000). Thus uncertainty and variability make it troublesome for payers to buy care from suppliers primarily based on quantity or high quality.

At the moment we contemplate how the Dutch pay for psychological well being care. Since 2006–with the introduction of the Well being Insurance coverage Act (HIA)–the Netherlands has had a system of managed competitors. On this system, people with psychological well being points are divided into these in outpatient settings (i.e., “healing”) and people requiring long-term residential care.

The inclusion of psychological well being care within the HIA was supported by the introduction of a brand new product classification system (Prognosis Therapy Combos or DTCs) that’s used for reimbursing suppliers for the completely different psychological well being companies. A DTC consists of all actions which are carried out and the time (in minutes) carried out for these actions. DTCs in psychological well being care consist of various product teams that cowl completely different quantities of time measured in ranges of minutes…Every DTC has its personal worth. Normally, a DTC that covers a better minute vary is extra costly than a DTC that covers much less minutes. After the DTC is closed, the insurer pays the contracted worth to the supplier…

Psychological well being suppliers negotiate with well being insurers about DTC‐costs and an annual finances that serves as ceiling. Psychological well being care suppliers obtain the negotiated DTC‐worth for each DTC they produce till they hit the annual finances. In precept, suppliers don’t obtain further funds in the event that they produce over the finances…In apply, nevertheless, contracts could typically be supplemented with further finances for instance if the variety of sufferers seems to be bigger than ex‐ante anticipated

Earlier than 2014, suppliers negotiated costs with a single consultant insurer of their space; in 2014, nevertheless, suppliers negotiated with every insurer individually. A paper by Brouns et al. (2021), makes use of this variation in how suppliers negotiate with insurers to look at how supplier market energy impacts the negotiated charges for psychological well being companies. Utilizing a proprietary insurance coverage declare dataset with info on all Dutch DTCs charges negoatiated between insurers and suppliers between 2013 and 2014, the authors discover that:

In 2013, the vast majority of the contract costs equaled these most costs…In 2014…well being suppliers reacted to this coverage change by setting most contract costs under the brand new most costs…psychological well being suppliers with extra market energy…contracted considerably greater costs. Some insurers negotiated considerably decrease costs than different insurers however these variations are unrelated to an insurers’ market share.

In brief, extra market energy had robust pricing results for suppliers, however much less so for insurers within the Dutch psychological well being pricing area.

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