The Minister of Health (VWS) wants to introduce budget funding for ER care from 2027. For now this is a limited introduction: each hospital receives EUR 4.6 million per ER location, and the same amount is stripped out of the current contractual arrangements, making it budget-neutral. It is an interim step towards a more meaningful budget funding model, which would require a vision for the acute care landscape.

The proposed form of budget funding does little or nothing to advance the government’s stated goals for acute care:

• more financial certainty for smaller hospitals;
• making it easier for hospitals and other partners in the chain to work together;
• reducing market forces in healthcare;
• working towards accessible acute care in every region.

At the same time, introducing budget funding creates a great deal of administrative work for all parties. It can also lead to undesirable side effects — for patients (in how they pay their deductible), for hospitals (through differences in tariffs between them) and for insurers (through price differences between insurers). Both the NZa and parties in the field note that the ‘stripping out’ required for the new model produces differences between providers and insurers. The size of those differences was, however, not yet known. Gupta has now quantified them. The differences can be especially large between hospitals, and patients will notice. The cost of an ER visit will soon range from EUR 100 to more than EUR 400, depending on which hospital you visit.

Our advice: better to turn back halfway than to keep going down the wrong path.