The Dutch Healthcare Authority (NZa) states in its Implementation Advice budget funding intensive care states that budget funding for intensive care (IC) is a drastic measure and not a suitable solution to keep IC care accessible. The potential benefits of this funding method do not outweigh the disadvantages. The NZa sees more chances to find solutions through the national work agenda started by all industry parties.
Risks and opportunities of budget funding
Budget funding can provide financial certainty, especially for small IC departments, because the need for production disappears. At the same time, it does not solve the staff shortage and the biggest challenge of IC care: the increasing tension between the declining demand for IC care combined with a shortage of IC nurses and the need to meet the minimum requirements to remain operational as an IC department. Financial uncertainty in current practice also seems limited. The main negative effect is that budget funding does not contribute to the transition to a future-proof organization of hospital care in the Netherlands. For these reasons, the NZa considers budget funding disproportionate for IC care.
National agreements for future-proof IC care
To keep IC care accessible in the future, it is necessary to deploy scarce staff as effectively as possible. We see the development that IC staff increasingly provide care outside the IC department to prevent IC admissions. The current production-based funding does not fit well with this. An important first step has already been taken by industry parties with the joint work agenda ‘Towards a future-proof IC landscape’. The NZa welcomes that the bottlenecks of IC care are addressed in this work agenda. This agenda is from Health Insurers Netherlands, Dutch Hospital Association, UMCNL, Dutch Society for Intensive Care, Nurses & Carers Netherlands, FCIC & IC Connect and Federation of Medical Specialists.
Room in contracting and funding
The current contracting offers opportunities to support the movement towards future-proof IC care, but this room is currently insufficiently utilized. To make good use of this room, national agreements are needed that stimulate the changing role and function of the IC within a hospital. The joint work agenda can be used to make these agreements. We will continue to critically monitor the actual implementation of the work agenda. This is essential to provide sufficient answers to the challenges of IC care.
Information card
Earlier, we already issued advice on the introduction of budget funding for emergency care and acute obstetrics. In this Information card the main differences between the three types of care are explained. This does not form a complete framework for future funding advice.
