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

2. 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 – % per year.

3. 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

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

5. 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”

6. 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

7. 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

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