Currently the care for the chronically ill, the disabled, and elderly persons in need of help falls under the responsibility of the local authorities. The 18,000 community nurses in the Netherlands play an important role in this care. They visit people at home, provide nursing care and assess how much care the patient needs (care needs assessment). Community nurses enlist the help of volunteers, family and friends of the patient (informal care). They also draw up a care plan, describing the type of care and for how many hours. This care plan is the basis for the payments made by the healthcare insurer.
At present, a community nurse is paid a different amount for each different type of care. For example, a distinction is made between non-medical care and nursing. In addition, some forms of care are paid separately, such as Advice, Instruction & Information, personal hygiene care, nursing and on-call nursing. The community nurse has to register and keep accounts for all of this, and this means a lot of time is spent doing paperwork.
In 2015, a majority in the House of Representatives backed a motion to the Cabinet asking for a simplification of the payment to community nurses so that they do not have to spend so much time on administration. The Cabinet investigated whether this administration could be automated, but this is not yet possible. Now the Cabinet has proposed that from next year a single rate should be introduced for non-medical care and nursing of patients. A separate rate will remain for nursing patients with dementia.
From next year, healthcare insurers and nurses will work together to draw up care profiles. From 2018, these will be used as the basis for the rate the community nurses are paid. They also have to agree on how the care provided to the patient should be registered. The old classification of care with the different payments will continue for the time being, for use by budget holders and for use by nursing providers who do not have a contract with healthcare insurers.