Dutch health care insurance companies say the Diagnosis Treatment Combinations (DTC) and the Diagnostic and Statistical Manual of Mental Disorders (DSM V) should no longer be the leading factors when making reimbursement agreements with mental health providers.
Two large Dutch insurance companies (CZ and VGZ, with 43% market share) in the Netherlands have pleaded for a reduced role of the DTC reimbursement system in the mental healthcare sector. Instead of DTCs, a transformation of the reimbursement system should be made towards ‘blended psychiatry’, where the experience of patients, knowledge of healthcare professionals, and knowledge from hard data are combined. ‘Blended psychiatry’ is not possible with the current reimbursement model, in which DTCs not always represent the real-life needs of a patient. More use should therefore be made of real world data as current protocols and guidelines are based on solidified knowledge which does not reflect reality - researchers measure and then make conclusions from solidified measurements (that is why scientific data in many cases does not reflect the dynamics and complexities of real life).
The current reimbursement model focusses merely on DTCs in combination with the DSM which stimulates a more controlling attitude for the stakeholders, whereas care should ultimately focus on the patient. Therefore, a switch should be made towards a more patient-centred attitude. In order to establish this, there should be more trust between stakeholders (insurance companies and healthcare professionals). Ultimately, this would lead to conversations about regions, populations and their patients, instead of yearly agreements on national level.
The president of VGZ (Ab Klink, former minister of health) is specifically pleading for more focus on learning from practical experiences instead of scientific indicators and guidelines. He argues that as long as there is sufficient variation in treatment (which is easier with e-mental health) the best practices will surface automatically. This is especially important for the mental healthcare sector, which has been using the DTC reimbursement system for about 10 years. In addition, the current system stimulates the use of certain diagnosis whether appropriate or not – it has become a system driven by payment titles.
In 2017, a pilot based on the English cluster model started in the mental healthcare sector. In this model the needs of the patient are central, instead of only the clinical diagnosis. The national healthcare authority in the Netherlands (NZa) wants to introduce this model from 2020 onwards.
A new reimbursement system for mental health care in the Netherlands is on its way, with a crucial role for e-mental health.
Source: this article is based on a translation of a Dutch article: https://www.skipr.nl/actueel/id38483-zorgverzekeraars-maak-dbcs-minder-leidend-in-ggz.html
https://www.staatvenz.nl/kerncijfers/zorgverzekeringconcerns-marktaandeel