A Dutch national perspective on chronic diseases and healthcare quality management Invitational conference on chronic lung diseases Utrecht September 23rd 2011 Arnold Moerkamp Dpt. Director General for Healthcare Ministry of Health, Welfare and Sports 1

Issues: 1. Challenges 2. Strategies 3. Integrated care 4 Issues: 1. Challenges 2. Strategies 3. Integrated care 4. Establishing a national healtcare quality board

Challenges Increasing healthcare demand The good news is: we live longer Increasing healthcare demand Shortage of manpower and funds in healthcare Ageing and technology Decreasing labour market Voettekst

How bad is that...? Shortage of manpower and funds Threat on financial sustainability Shortage of manpower and funds Threat on healthcare solidarity Threat on healthcare quality Voettekst

Four possible strategies Professional treatment of only half of the patients by prioritising Double productivity by financial incentives and new IT based technologies Halve healthcare demand by prevention and integrated healthcare for chronic diseased All possible combinations Voettekst

How do we do that...? Prioritise patients Increase productivity Reducing inter-doctor variation Prioritise patients Reducing insured entitlements Pay for performance Increase productivity Increasing burden of risk insurance co’s. Reduce healthcare demand Integrated care National healthcare quality board Voettekst

Integrated care: better care, lower costs good practices, to name a few... - Integrated COPD care (Mid Holland region) - Multidisciplinary program heart failure (Noordwijk) - Disease management program DiabeteszorgBeter (Northern region) - Transmural cooperation GP’s and Med.Spec. (Southern region) more good practices on WWW.denieuwepraktijk.nl Voettekst

Preconditions for integrated care rearrangement of the healthcare landscape back to basics at the local level rearrangement of the professional landscape MS  GP’s NP’s  self management cooperation at the local level end of mono disciplinary practices e-health support supporting self management Voettekst

Integrated care so far disease management arrangements e-health needs boost cooperation is growing 2007: 40% of GP practises multi disciplinary 2011: 50% Developing: Heart failure Depression Obesity Dementia CVA Diabetes COPD VR Voettekst

Formal cooperation primary healthcare 2007 2011 Voettekst

A national institute for healthcare quality The national institute will facilitate, assess, register and publish professional standards A professional standard includes patient focussed integrated description from start to end of (multidisciplinary) treatment, professional guidelines, quality and safety standards, quality, safety and efficiency indicators, outcome indicators and benchmarks The national institute will publish information to facilitate patients to make their choices, insurance companies to contract healthcare providers, the national healthcare inspectorate to supervise and enforce Voettekst

The national institute: beyond permissiveness Professionals and patients in the lead, the national institute will facilitate The national institute will set a meta standard and assess professional standards The national institute will take over if a proposed professional standard doesn’t meet the meta standard The national institute will facilitate implementation of a professional standard Voettekst

Summary Sustainability of future healthcare urges to reorganize the healthcare landscape Patient focussed integrated care enables better care at lower costs Focus on quality performance and transparency of outcomes will challenge professionals to perform better The new national institute for healthcare quality will focus on efficient integrated care and outcome performance and thus will contribute to sustainable future healthcare Voettekst

Thank you Voettekst