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268 Economic crisis, health systems and health in Europe: country experience
and the government in 2011 (National Hospital Association & Ministry of
Health, 2011) 11 in which health insurers agreed to expand selective contracting
starting in 2012. At the same time, in 2014, the basic health care premium
decreased, which is remarkable after years of increases.
There were no major changes in the payment system for health care providers
between 2006 and 2012. An experiment with free prices for dental care in 2012
was abolished in 2013 because it led to higher costs instead of cost-containment.
For other providers where the reform of 2006 had led to overspending, mainly
reductions in the budgets for tariffs have been introduced.
As discussed above, in 2012, an agreement was signed between the Ministry of
Health and GPs in which the latter agreed to promote prescription of cheaper
medicines and a reduction in the number of prescribed drugs. It was estimated
that this would bring savings of about €50 million in 2013. If the saving was
not achieved, the difference between the actual amount saved and the planned
savings would have been subject to a tariff measure; currently (2014), it is
not clear if the saving was achieved and what the next steps will be (National
Association of General Practitioners & Ministry of Health, 2012).
The 2013 agreement between GPs and the Ministry of Health contained the
intention to introduce a new payment system in 2015. The new payment
system would distinguish three segments: (1) provision of basic GP care, (2)
multidisciplinary coordination of care for chronic diseases, and (3) incentives for
innovation and improved performance. The new payment system should take
into account population characteristics as determinants of health care needs,
emphasize substitution from secondary to primary care and from primary care
to self-care, facilitate payment for performance through negotiations between
GPs and insurers (e.g. linking remuneration to health outcomes should be
possible), 12 be transparent and as simple as possible, and contribute to control
of costs at the macro level. It is unclear just what level of savings this measure
may generate, but the emphasis on substitution from secondary care to primary
care and from primary care to self-care and prevention should be central in
generating savings.
In 2014, a new remuneration system for mental health care was introduced.
Whenever possible, patients with mental health care problems would be treated
in a GP practice (by a GP assisted by a practice nurse specialized in mental
health care) (see section 3.3). If the problems are too severe, the patient would
be referred to basic mental health care (outpatient based), where four different
care products exist: short-term, medium-term, intensive and chronic care.
11 This 2011 agreement differed from the agreement described here. Many agreements are signed each year between
various parties and only selected agreements are described in this chapter.
12 How innovation and performance are to be rewarded is yet to be developed (National Association of General
Practitioners & Ministry of Health, 2013).