National Authorization Protocol

Maternity care through the National Authorization Protocol.

Introduction
For every person, maternity care falls under the basic provisions of the new health insurance system as per January 1, 2006. This system was chosen because the Netherlands finds maternity care of great importance. Maternity care helps mother and child to make a good start in this very special phase of life.

What changes?
The organizations¹ involved with maternity care have agreed to improve the authorization for maternity care even more as per January 1, 2006. No longer by (sometimes) nontransparent rules which are different at a local level and can therefore be very unclear for you as a client. From now on, maternity care must be tuned to what a particular mother and a particular baby really need in their maternity period.

The National Authorization Protocol
To achieve this, these organizations prepared a National Authorization Protocol for Maternity Care with the greatest care: a guideline which maternity care providers, obstetricians and insurance companies all over the country can use to determine in the same way what kind of maternity care is necessary. For each individual situation, so that every person in the Netherlands can count on maternity care in proportion, with an equitable and even distribution of the available means and capacity.

Maternity care and volunteer aid
Everyone in the Netherlands is therefore entitled to maternity care. Maternity care means that mother and child can receive the care, guidance and support they need at home. Our maternity nurses have received special training for that purpose. The contemporary maternity care goes hand in hand with volunteer aid. The mother herself is responsible for making the necessary arrangements for this volunteer aid, as is the case in other homecare situations. By volunteer aid we mean the kind of aid people give to each other voluntarily, for example your partner, housemates, grandparents or neighbors. Your maternity nurse does the mother-, and babycare related basic household work. For all other household tasks, which the new mother is unable to do temporarily, volunteer aid is to be called in. This volunteer aid involves things such as care for the other children of the family, obtaining the groceries and cooking hot meals. It is important to make arrangements yourself sufficiently ahead of time for such volunteer aid to be available during the period after the delivery.

How does it work practically?
The kind of maternity care that applies to your personal situation is determined as objectively as possible on the basis of the National Authorization Protocol. This is the guideline by which the nature (the form) and the extent (how many hours) of maternity care that is necessary are determined.

At three points in time, the kind of maternity care that is necessary will be determined. This is what we call the determination of authorization. The first time is when a pregnancy is no more developed than 36 weeks. A professional enrollment employee will determine the form of maternity care that is required for the particular mother and particular family. This is the basis on which the number of hours of maternity care to be granted is initially determined. In principle, the enrollment employee will come to your home when you are expecting your first baby. When you are expecting a second, third, or later baby, depending on your personal situation, an interview can take place either at your home or by telephone.

But of course there are many unknowns before the delivery actually takes place. Therefore, the kind of care that is to be provided is reconsidered at two other times. One is the day of delivery, the other the third or fourth day after the delivery. Because then it will be clear what kind of care mother and baby really need. Your own obstetrician (or physician) and maternity nurse together will make these second and third estimations. If necessary, the maternity care to be provided will be adjusted at this time, if needed. This is what we call re-authorization. This could mean that you will ultimately receive more care than was originally determined to be appropriate. However, it could also happen that the 'package' of care originally proposed later appears to be excessive. What kind of maternity care you receive and for what reason, will be documented in your maternity file, so that progress can be monitored at all times.  

Maternity care in proportion
The result of this way of working will provide the level of maternity care that is necessary to give you and your baby a good start. For this purpose, the maternity care offers support in the area of mother and baby care, instruction, advice and information, the provision of good hygiene and basic household work. Your maternity nurse will monitor your situation, so that she can also inform your obstetrician and/or physician about the progress of the period of your maternity. If your delivery goes well in every aspect, you will be granted the basic maternity care of 49 hours. Depending on your personal situation, hours can be increased or reduced, as necessary.

Conclusion
We hope that this information clarifies the way in which homecare is granted and the idea that the procedure is the same for every person. Your maternity care provider and your health insurance company can give you more information. The law requires a monetary contribution (co-payment) per hour in each maternity case (for 2008 the tarif is € 3,70 per hour). You will receive an invoice from us after you maternity period is closed. Most of the times you can declare these costs at your health insurance company, depending on your insurance policy.

 ¹ The organizations which have written the National Authorization Protocol and agreed to follow this procedure, are the Royal Dutch Organization for Obstetricians KNOV, the Dutch Homecare Branch Organization BTN, the Dutch Homecare Entrepreneurs Organization Z-org, STING (National Homecare Trade Organization) and the Dutch Branch Organization for Health Insurance Companies.