Abstract
From January 2006 a new structure for additional STI care was introduced in the Netherlands. Previously, STI care was provided by a range of different physicians and institutions with inconsistent quality and at different costs. Since 2001, the STI clinics and Municipal Health Services (MHS) report a continuous increase in the number of consultations. Also, the financial structure was inadequate to cover the active testing policy with respect to STIs including HIV. In the new structure for additional STI care, the country has been divided in eight STI regions, representing all 29 Municipal Health Services (MHS). In each region, a coordinating MHS developed an STI control plan with the other MHS and clinics in the region. The Ministry of Health developed an innovative financial system based on the number of inhabitants per region and financial incentives for a higher STI positivity ratio (= number of diagnoses / number of consultations). The average positivity ratio was calculated from STI surveillance data. As such, diagnosis and treatment of 5 STI (Chlamydial infection gonorrhoea, syphilis, HIV, acute hepatitis B) will be financed. The financial incentive stimulates the MHS to focus on high risk groups.
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