Budgeting and financing of ambulance care
In the Netherlands, health insurers are responsible for purchasing ambulance care. To this end, the health insurers have access to the national macro budget that is determined by the Minister of Health, Welfare and Sport.
The financing system for ambulance care makes a distinction between budgeting and financing. Budgeting refers to the budget that is made available by health insurers each year on the basis of policy rules laid down by the Dutch Healthcare Authority (NZa). Financing means the manner in which the budget is made available through invoicing.
The Minister of Health, Welfare and Sport periodically determines the National Reference Framework for Distribution & Availability. In this framework, the minimum ambulance capacity required is calculated for each region and part of the day (morning/afternoon/evening), with a distinction according to the type of day.
The availability of ambulance care is one of the key features of ambulance care. Everyone must be able to rely on access to ambulance care at any time of the day. Therefore, this availability (capacity) is central to budgeting. The number of call-outs (production) only has a very limited direct influence on the size of the available budget.