Mental healthcare

Our vision of healthcare: Mental healthcare

For optimal mental health, it is not only important to recover medically, but also to be able to participate fully in society. We believe it is important that care is received in the insured person’s home environment as much as possible.


The care must be arranged in such a way that it meets the needs of the patient and that they can influence the care they receive. The starting point is that the treatment is aimed at functioning in daily life and recovery. Treatment goals are always set together with the patient and, where possible, in consultation with those around the patient. It is important to explicitly link up to care and support provided from other domains. We encourage the Right Care in the Right Place movement. This requires practitioners to know who the chain partners are in their region and how cooperation can be sought.

What does not fall under our purchasing domain?

Mental healthcare provided by nursing or care home institutions for the mentally disabled falls outside this purchasing domain. This care falls under the Long-Term Care Act. As from 2015, mental healthcare for persons up to the age of 18 falls under the Youth Act rather than the Health Insurance Act. If you have any questions about this, please contact your local authorities. In principle, we also do not purchase mental healthcare that is provided abroad.

Are you a care provider?

HollandZorg is part of Eno Zorgverzekeraar. You will find our purchase policy and the principles of this policy on the Eno website.

 

1. Vision on healthcare

1.1 Why do we conclude agreements?

We conclude contracts with healthcare providers to guarantee they comply with the basic quality requirements and to ensure they make sure the care they provide is cost-effective. We believe it is important that quality and efficiency come first and that care remains affordable. This is all provided for in the agreement.

1.2 How do we organise our purchasing?

From 2021, Salland will independently purchase healthcare. For contracting, Salland makes a distinction between custom agreements and digital contracting. Salland makes this distinction based on, among other things, the needs of the insured persons, the market share of the care provider and the region in which the care provider is located.

 

For secure care and acute mental healthcare, we follow the national agreements made by the representative insurer in accordance with the national purchasing frameworks.

1.3 Things to look out for when purchasing

In our purchasing policy, we pay special attention to, among other things, the approach to waiting times. We believe it is important that care is provided within the Treek standards. Where waiting times do exist, we aim to reduce these, in collaboration with the field, to within the Treek standards. We are committed to purchasing sufficient care and use healthcare mediation on behalf of our insured customers. In addition, we would like to support and facilitate initiatives that contribute to this.

1.4 Requirements for care providers and care provision

As a framework for our quality policy, we use what is classified as insured care by the Health Insurance Act. We assume that only treatment methods are used ‘in accordance with the latest scientific and practical knowledge.’ The guideline is the list of permitted mental healthcare treatment.


We consider quality within mental healthcare and improving it important. The basis for this is the model quality standard and the care standards as developed by the field.

2. What freedom of choice does the insured have? 

You may choose any healthcare provider. We have concluded agreements with numerous institutions and independent surgeries. This means there is always a contracted care provider in your area.

In addition to our contracted care providers, you may encounter non-contracted care. They are institutions or surgeries that are unable to meet our basic quality requirements, or that opt not to conclude a contract with us.

We apply maximum reimbursements for care provided by non-contracted surgeries and institutions. We always recommend contacting your healthcare provider to find out if he has a contract with HollandZorg or if he would consider concluding one after all. You can use our care finder to find contracted care providers.

As soon as you have found a care provider, it is wise to make arrangements with him/her about your treatment: what are the objectives? How are these objectives achieved?

3. Special/innovative arrangements

We pay a higher rate to independent surgeries of psychologists and psychiatrists who, in addition to complying with the basic provisions of the agreement, have a recognised training place.

 

HollandZorg applies specific agreements for addiction care, with the report ‘Focusing on addiction care’ of the National Health Care Institute serving as a guideline. With this, Eno wants an efficient and lawful purchase that is effective for insured persons.

 

Patients who enjoy uninterrupted accommodation and treatment at a mental healthcare institution for more than 365 days, but fewer than 1095 days, are eligible for continued residence under the Health Insurance Act. Care providers who provide this care, demonstrably have facilities and programmes that promote the self-reliance of the patients, which makes it possible to make care ambulatory and the patient can return to the home situation or a protected form of housing. When purchasing long-term mental healthcare, we consider it a requirement that the provider applies a clear policy with regard to the inflow and transfer of insured persons. For 2021, this applies specifically to patients transferring from the Health Insurance Act to the Long-Term Care Act. At Salland, prior to the transition to long-term mental healthcare (the second year of residence) and in the event of an extended continued stay (the third year of residence), an authorisation must be requested by the care provider on behalf of the insured person. The application for this authorisation must be submitted to us no later than two months before the anticipated transfer. The care provider applies the nationally agreed checklist for prolonged medical mental care.

4. More information

We will be happy to provide you with more information about our healthcare providers. If you have any questions or issues, please contact our care service team, so that we can discuss your situation. This enables us to give you the best advice.