Health-care costing in the Netherlands

Introduction With the introduction of the DBC system in 2005, the funding of Dutch health care gradually began to change. The DBC system is replacing the current system of position-based budgeting (block grant) of providers and the lump-sum funding of medical specialists. In 2005, two segments were introduced for somatic health care. An A-segment, with fixed national tariffs for health providers and medical specialists, is used for billing only. Block grants still exist for actual costing. In the B-segment, provider prices are set based on local negotiations between provider and insurer, combined with fixed national tariffs for medical specialists. With the B-segment, market principles were introduced in the Dutch health-care system. Naturally there was, and still is, a strong political involvement in the size and composition of the B-segment which, at this moment, comprises about 34 percent of annual hospital turnover. In 2008, lump-sum funding for medical specialists was replaced with a remuneration system based on work load and a fixed hourly rate. In 2011, the next step toward performance funding is planned. Block grants for providers in the A-segment, including mental health care, should be replaced by actual costing based on DBC tariffs. However, this was deferred to at least 2012 due to the current political situation. In the long run, the B-segment will comprise about 70 percent of annual hospital turnover.