88 Chapter 3 Last, survey respondents expressed that calendar age should be less strictly applied to determine transition, and alluded to the importance of specialised age-specific services that focus on the years during which the transition occurs [7]. Policy changes in the Netherlands We have identified some relevant changes in the Dutch mental health care system during our study period. Changes to the predefined benefit package included removing coverage of psychoanalysis (2010), treatment of adjustment disorders (2012), and treatment of “Other conditions which are reason for concern” (2013). There was also a reduction in the number of basic mental health services appointments covered, and a slight increase in copayments for these (2012), that were later removed (2013) [9]. The 2014 reorganization of service segments reinforced the role of basic care, with the objective of reducing the use of specialist care [10]. Given that our binary outcome captures both basic and specialist care, the 2014 reorganization should not impact our results. This reform also increased the role of GPs in providing short-term support to mild disorders, mostly through mental health nurses that are part of general practices. Importantly, both the 2014 reorganization and the changes in coverage impacted adolescents before 18 and young adults after 18, and not the discontinuity at 18. These changes are therefore not expected to drive our results and should be mostly captured by inclusion of year fixed effects in the estimation approach. An exception is the implementation of co-payments for adult specialist mental health care during 2012, from which adolescents were exempt. During 2012, adult patients were required 1) a copayment of 100 euros to open an outpatient treatment record and an additional 100 euros if they exceeded the total of 100 minutes of care during that record; and 2) a monthly co-payment of 145 euros for inpatient care. As these co-payments were abolished from January 2013 onwards we address this change by excluding the year of 2012 from our research.
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