Changes in the financing of mental health care and the implications for care purchasing May 24, 2005

Mental health care in the current care environment Mental health care financed entirely by Exceptional Medical Expenses Act (AWBZ) Health insurer - via care office structure – mandated by other insurers to purchase mental health care within specific region Purchased for all residents of that region Insurer does not run any risk Growth in mental health care expenditure 2000 – 2004 8% per year.

Mental health care in the future (from 1-1- 2007) Mental health care purchased via DBCs by competing health insurers, recorded in individual contracts Inclusion of mental health care products and services in policies, own risk, refund opportunities, no claim etc. Care statement by care providers at customer level in terms of DBCs Mental health care substantial part of total purchasing (ca. 15%) Insurers will run a mental health care risk

Changes require clear purchasing strategy Strategy must incorporate the following aspects Affordability Accessibility Quality

Determine impact on affordability in various steps First step: Determine biggest “cost – drivers” in mental health care Second step: Develop instruments to influence “cost – drivers”

Examples of biggest “cost – drivers” Influx = Number of referrals per 1000 inhabitants from 1st to 2nd line Throughput = Duration and number of 2nd line treatment contacts

Examples of purchasing instrument to manage influx Pay for performance: 1st line is responsible for influx. Encourage entrepreneurship and reward with support and shared responsibility. Enable measurement of result using performance indicators and rewards P.I. = number of referrals per 1000 inhabitants from 1st to 2nd line compared with similar regions = Development in number of referrals compared with T-1 = Customer experience

Examples of purchasing instrument to manage throughput Benchmarking: Compare costs of each care option Compare waiting times within each option Compare relapse percentage