Health system performance in the Netherlands

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Presentation transcript:

Health system performance in the Netherlands Philip van der Wees Joost Wammes Gert Westert IQ healthcare May 18, 2017

The Netherlands 17 Million citizens Size similar to Massachusetts GDP/c: $48.000 Life expectancy: 79.7 (m); 83.1 (f)

The Dutch Health Care System ”Solidarity with regulated competition” Regulated via four legislative systems: curative care, long term care, social support, care for children and adolescents Mix of public (90%) & private (10%) financing Total health care costs around €95 Billion (11% GDP) Primary care Primary care with ~10,000 primary care physicians in ~5,000 practices Primary care physicians mainly self employed, reimbursed via capitation and (limited) bundled payment Hospital care Hospital care in ~90 hospitals (8 academic) and ~250 independent treatment centers with ~22,000 medical specialists Specialists either in group practice (54%) or employed by hospital (46%) Hospitals reimbursed via diagnosis-related groups

Curative care Reform in 2006: establishing a regulated market system. Objective: increase efficiency and quality with regulated competition and individual choice of citizens/patients Characteristics: Health insurance mandate for Essential Health Benefits (99.9%) Additional coverage (84%) Paid via premiums/deductibles (50%) and income dependent taxes (50%) Average annual premium around €1200 Annual mandatory deductible €385

Long term care Reform in 2015: major shift from residential to non-residential care Objective: to limit expenditure growth in safeguarding fiscal sustainability and stimulate client-centeredness Characteristics Largely publicly funded (€20 Billion) Individual/social responsibility via informal care Shift from residential to non-residential care (living longer at home) Decentralization of non-residential care through municipalities

International Health Policy Survey 2016

How easy was it for you to receive care in the evening or in the weekend? (% easy/very easy) Access to health care is excellent

Your primary care physician…(% full agreement) Important role of primary care physician

Did the hospital provide aftercare or ensured you would receive aftercare from a health care professional? (% yes) Coordination between hospital and primary care should be better

Conclusions Strong performance: Strong primary care system with a primary care physician for (almost) all citizens Weekend and after hours care organized by primary care physicians Points for improvement: Organization and coordination of aftercare after hospital discharge is limited Implementation and evaluation of long term care reform is still underway