Dutch Healthcare Authority announced academic care contribution for highly specialized and innovative care in 2024

Annually, the Dutch Healthcare Authority (NZa) issues a policy rule that defines the amount for academic care contribution (Beschikbaarheidbijdrage Academische Zorgand, BBAZ) and the rules for its allocation. This policy rule aims to determine the reimbursement for costs that arise for certain healthcare providers because they permanently maintain facilities (staff and infrastructure) that enable them to provide so-called academic care. Academic care is highly specialized care accompanied by special diagnostics and treatment for which referral is no longer possible, requires an infrastructure in which many specialists work together at the highest level of expertise, and is linked to fundamental patient-centered research.

The academic care contribution (BBAZ) includes payment for top-quality patient care and keeping the infrastructure available for fundamental scientific research. In addition, it is intended for devising, testing, and disseminating new treatments and diagnostics and the development and innovation necessary for treating top referral patients.

Two compartments are distinguished within the BBAZ:

• A compartment one of €940,886,231 in 2024 for healthcare providers where top referral care is not fully funded through available services and tariffs;
• A compartment two of €13,516,253 in 2024 for healthcare providers where top referral care is fully funded through available services and tariffs.

The resources available for the BBAZ compartment one include a variable component of €611,576,050 (65% of the total BBAZ) to fund top referral patient care and €329,310,181 (35% of the total BBAZ) to fund the fixed or Research and innovation part.

The fixed part is intended for the infrastructure, the knowledge component, and the research and innovation structurally required to treat top referral patients. The contribution for the fixed amount is justified based on nine cost categories, including unfunded investments for innovative equipment and IT, medical care that currently is not reimbursed (no DRG yet), conditional provision of care in connection with clinical research (not reimbursed elsewhere), etc.

The variable part is intended for the care of top referral patients and varies with the number of top referral patients that a BBAZ recipient treats. It is designed for DRGs for which the tariffs do not provide sufficient coverage. 

The variable part is justified based on the additional costs realized based on the labeling system. The labeling system consists of seven distinguishable patient-related labels, including patients with a high treatment intensity, patients who require multidisciplinary care, etc. For each label, variables that may apply to a patient have been determined; if a patient falls under one of these labels, it is considered a top-priority patient.

DRGs supplied almost exclusively by academic care providers are considered unique. Since the tariffs for these unique DRGs are almost entirely based on the cost data of the BBAZ recipients, they are assumed to cover costs being cost-effective. These DRGs, therefore, cannot be covered by BBAZ.

The full details in Dutch can be found here.

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