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Chapter 8 | The impact of the crisis on the health system and health in the Netherlands
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Changes to mental health care
The budget for mental health care was cut by €119 million in 2010. In 2012,
reductions of the budget and the tariffs on curative mental health care were
set with the aim of achieving a saving of €222 million in 2012. To put this
in perspective, in 2010, the total turnover of mental health care providers
was €3956 million for curative mental care and €1431 million for long-term
mental care. How the reductions would affect different providers of mental
health care would be decided by the Health Care Authority. Reductions in both
years (2010 and 2012) largely concerned curative mental health care under
the Health Insurance Act provided by self-employed and institutional mental
health care providers.
Changes to long-term care
The budget for long-term care also experienced cuts, including measures such
as a reduction of entitlements for personal budgets and for counselling (see
Table 8.3). In 2013, geriatric rehabilitation care was shifted from the Exceptional
Medical Expenses Act to the Health Insurance Act (see section 3.2). From
2015, a structural yearly budget cut of €50 million is predicted and a major
reform of long-term care is planned for that year.
3.2 Shifting costs between various statutory sources
Statutory financing has been reorganized with costs being shifted among
various statutory sources. For example, some of the care previously insured
under the Exceptional Medical Expenses Act was shifted to the Health
Insurance Act (geriatric rehabilitation care in 2013) or to the municipalities
(psychological counselling in 2009), often with decreases in the budgets. In
the reform of long-term care, which is under consideration (2014), there are
plans to shift more long-term care from the Exceptional Medical Expenses Act
to other acts, decentralizing its financing and governance, and decreasing the
respective budgets. The reason for shifting long-term care to the municipalities
is the idea that they can provide it more efficiently. Personal care, such as
assistance with activities of daily living (algemene dagelijkse levensverrichtingen),
and counselling will be removed from coverage under the Exceptional Medical
Expenses Act and transferred to either the health insurers or the municipalities.
The exact division of tasks is currently the subject of a political debate. The
important difference between shifting care to the municipalities or to coverage
under the Health Insurance Act is that care provided by the municipalities is
compensation based (i.e. citizens have to be compensated for their disabilities
in such a way that they can participate in society) and care provided under
the Health Insurance Act is rights based (there is a list of entitlements). This