For people with (imminent) psychiatric crises, it is crucial that High & Intensive Care (HIC) and Intensive Home Treatment (IHT) are available throughout the Netherlands. A exploration by the Dutch Healthcare Authority (NZa) into these two parts of crucial mental health care (ggz) shows that there is still too little insight into the organization and quality of this care and national bottlenecks. As a result, it is not yet possible to determine which form of funding and procurement is most appropriate and actually contributes to the availability of care for these vulnerable patients. However, important steps are possible in the short term to improve the accessibility of HIC and IHT.
Major change
Currently, HIC and IHT are largely purchased through regular performances within the care performance model and to a lesser extent through budget funding for acute mental health care. The NZa conducted the exploration at the request of the Ministry of Health, Welfare and Sport, with the question of whether budget funding with procurement in representation can contribute to appropriate funding and procurement so that sufficient facilities are available for the most vulnerable. The NZa also shares the importance of this. As with earlier advice on budget funding for acute obstetrics, intensive care, and emergency care, a major change in funding is only responsible if it is clear what problem it solves and under what conditions. At this moment, that clarity is missing for HIC and IHT.
Short-term steps
At this moment, the NZa cannot give definitive advice on the most appropriate funding and procurement, or on the use of budget funding with procurement in representation. However, important steps are possible in the short term. For example, involved parties can collaborate on a clear framework of standards for the organization and quality of this care. In addition, better insight is needed into the nature of the care, care providers, and patient groups. Insurers can also make mutual agreements to better align procurement and possibly make use of options within the funding of acute psychiatry. The NZa advises to start working on the actions from the established work agenda. Insurers and care providers also have and maintain an important role in this. We expect to give advice again in the course of 2027. At the same time, we intensify our supervision of insurers and care providers in crucial mental health care.
Previous advice on budget funding
The NZa is committed to accessibility and affordability of care. We do this, among other things, through the development of funding. Previously, we have already issued advice on the introduction of budget funding for emergency care, acute obstetrics, and intensive care. In this Information Card the main differences between these types of care are explained.