Tasks of the National Health Care Institute
The National Health Care Institute (Zorginstituut Nederland) carries out tasks relating to two Dutch statutory health insurance schemes: the Health Insurance Act (Zorgverzekeringswet) and the Long-Term Care Act (Wet langdurige Zorg, Wlz). The National Health Care Institute’s role in maintaining the quality, accessibility and affordability of health care in the Netherlands involves four tasks:
- managing the basic health care package;
- encouraging improvements in health care quality;
- advising on innovations in health care professions and education;
Health Care Coverage
Health Care Coverage is one of the National Health Care Institute’s programmes. This programme’s main role is managing the basic health care package in order to ensure that it contains all necessary care, but no more than is required. We achieve this by:
- advising the Dutch Minister of Public Health, Welfare and Sport on the content of the basic package and on the Health Insurance Act and the Wlz, on the basis of financial and social considerations;
- clarifying the basic package, for instance, in response to disputes between health insurers and insured clients.
Health Care Quality
Health Care Quality contributes to good health care by helping the parties involved continually improve health care and helping patients find their way to good-quality care. The programme achieves this by:
- encouraging and supporting the health care parties responsible for drawing up quality standards and relevant measuring instruments.
- encouraging health care parties to comply with these quality standards, use ‘good practices’
- providing insight into the quality of care provided. The programme collects data on quality of care and ensures these data are accessible. This information helps patients make choices in health care and facilitates the supervision of health care.
Health Care Professions
The National Health Care Institute’s Innovative Health Care Professions programme advises the Dutch Minister of Health, Welfare and Sport on innovations and improvements in health care professions and education. The programme plans to develop a new classification of professions and to design the right educational structure for the entire health care sector. The Health Care Professions programme’s starting points are future demand for health care, and social and technological developments in the provision of care.
The National Health Care Institute has the following tasks relating to funding of the Health Insurance Act and the Wlz:
- manages all contributions that employers and benefits agencies pay for health care expenses; i.e. income-dependent contributions for the Health Insurance Act and Wlz contributions.
- divides contribution funds among health insurers (risk adjustment) and health care liaison offices, and issues health insurers and health care liaison offices with budgets for administrative expenses within the framework of the Wlz.
- implements Wlz subsidy regulations, such as extramural treatment, ADL-assistance (ADL stands for Activities of Daily Living) and primary care residence.
- supports implementation of the Wlz and the Social Support Act (Wet maatschappelijke ondersteuning, Wmo) by managing information standards (iWlz and iWmo)
Taking care of good healthcare
Every person in the Netherlands is entitled to health care offered in the basic care package.
We all contribute to this through our health insurance.
The National Health Care Institute determines and advises on which types of health care are included in the basic package and which are not.
Treatment possibilities and their related costs have increased in recent years, and will continue to increase.
These treatments are also often used for a broader group of patients.
The Care Institute therefore wants to draw more attention to how insured care can be offered. Who receives which care?
Professionals largely determine what type of care to offer for which health issue.
But... is this care necessary and effective for every patient? Is Appro¬priate Care being applied?
To determine this, we need to focus on what takes place in the consultation room, where the doctor and patient together decide on the best treatment.
This requires good collaboration with professionals and patients on the ap¬plication of Appropriate Care.
We encourage health care parties to structure their guidelines and quality standards to provide the individual patient with the proper care.
We do this together with scientific organisations, as well as health care pro¬viders, patient organisations and health insurers.
In other words, we continuously monitor the scope of the basic package.
We also call for greater focus on collaboration to ensure appropriate care.
This enables us to reduce pressure on the boundaries of the package and keep the insured care accessible... of good quality... and affordable, now and in the future.
Taking care of good healthcare – no more and no less than necessary
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Organisation structure National Health Care Institute