Earlier this year, the National Health Care Institute published the Appropriate Care Framework . We see various proposals in it that will have far-reaching consequences for the organization of healthcare in the period up to 2040. We would like to draw your attention to a number of major themes in this. The Framework describes developments that must be achieved by 2040.

• Health insurers and care administration offices only purchase care that has been proven to be effective and efficient. The rate depends on the extent to which efficiency can be demonstrated. (P.14, bullets 1 and 4). This means that organizations (no matter how large or small) must be able to demonstrate efficiency. It takes time, manpower and agility to be able to provide good insight into this.
• Care organizations and their representatives are expected to cooperate in (regional) networking with partners within and outside the care sector. This is also reflected in the funding. This requires regional attention to the vision, purpose and governance of the network and raises issues of effectiveness, sovereignty, partial interests and the shared interest. (P.13, P.15 point 5). We are prepared for this with the Medical Child Care Cooperation (MKS) and the development of the Integral Child Care Networks (NIK). Further development is necessary in order to meet the changing requirements. Network collaboration is beyond noncommittal.
• Health insurers and care administration offices are being asked to purchase and contract more in conjunction. The smaller insurers in the region must follow the lead of the two largest insurers to shape appropriate care. (P.14 point 2)
• Appropriate care starts with self-care and informal care. Only if this cannot contribute sufficiently will formal care be used. (P.9) This requires vision formation by the field.

This report shows a new reality in 2040 and asks the organizations in the field to move along with it. These developments are primarily aimed at curative care, but will also have an effect on the social domain and palliative care. We see that this report does not stand alone. The broad outlines were also discussed during the NIK day in September 2021 in response to the report ' Broad social reconsiderations ' (Ministry of Finance, April 2021). They can also be seen in other publications such as the Exploring sector-transcending payment title (Dutch Healthcare Authority, July 2021) and the draft Integrated Healthcare Agreement that was published in September 2022.

We look forward to discussing these developments with you and how we can prepare for the future. It is a change that we can only achieve together.

Meggi Schuiling-Otten
Director Knowledge Center Pediatric Palliative Care