The Dutch Healthcare System AEMH/FEMS - LISBON June 7th 2018

Age structure 2018, 17.182.000 inhabitants 100 75 50 25 AEMH/FEMS - LISBON JUNE 7th 2018

Age structure 2050, 18.370.000 inhabitants 100 75 50 25 AEMH/FEMS - LISBON JUNE 7th 2018

Life expectancy 2016 Total Women Men Average age at death 78,1 80,5 75,6 Life expectancy at birth 81,5 83,1 79,9 AEMH/FEMS - LISBON JUNE 7th 2018

Key data Total number registered doctors: 45 Key data Total number registered doctors: 45.969 (KNMG, December 2017) MS contracted by hospitals: around 8.600 (CBS, 2016) Number general hospitals/locations: 79/121 (2016) Number academic hospitals: 8 Expenditure on hospital care and long-term care: 83,8 billion (2016) % GDP, international standard: 10,5% Base: healthcare always available and accessible for everyone AEMH/FEMS - LISBON JUNE 7th 2018

Education - Graduate training, duration 6 years, 3 Education - Graduate training, duration 6 years, 3.000 students - Next step: specialization (postgraduate training). Independent institution advices the ministry about numbers of doctors for each specialism (regulation) - Problem: unpopular specialisations - Problem: long waiting time until start of postgraduate training AEMH/FEMS - LISBON JUNE 7th 2018

Technological developments - Electronic Patient Record is still not functioning well - Report KPMG: technological innovations go too slow - On the other hand: many local initiatives and collaboration between healthcare organisations and healthcare insurance companies to stimulate innovations AEMH/FEMS - LISBON JUNE 7th 2018

Labour conditions Medical Specialists Two important CLA’s: General Hospitals and Academic Hospitals In both CLA’s seperate agreements on labour conditions for MS are made EWTD: Choice is made not to apply the EWTD on doctors. However, EWTD is applied on doctors in postgraduate training. AEMH/FEMS - LISBON JUNE 7th 2018

Netherlands, country of immigration of doctors Netherlands, country of immigration of doctors? Recent study shows the opposite: Last 10 years… - About 5.700 doctors left The Netherlands - About 2.700 entered the Dutch labourmarket AEMH/FEMS - LISBON JUNE 7th 2018

Financing the healthcare system (I) Starting point: high quality healthcare, accessible for everyone Patient does not notice if his doctor is salaried or independent ‘Zorgverzekeringswet’ (Care insurance act) - Obligatory basic insurance, about € 1.200,- per person per year - Deductible: € 385,- euro per year for everyone above 18 years - Income-related contribution employers - 60% of the medical is financed by this act ‘Wet Langdurige zorg’ (Longterm care act) - Care for people in need of permanent monitoring or 24-hour care - Contribution via income tax AEMH/FEMS - LISBON JUNE 7th 2018

Financing the healthcare system (II) ‘Wet maatschappelijke ondersteuning’ (social support act) - Care for people who are less able to participate in society - Execution by local government - Financed by central government ‘Jeugdwet’ (youth act) - Specific legislation for youth care - Execution by local government - Financed by central government AEMH/FEMS - LISBON JUNE 7th 2018

EHCI 2017 Quote: ‘ The Netherlands is the only country which has consistently been among the top three in the total ranking of any European Index the Health Consumer Powerhouse has published since 2005. The 2012 NL score of 872 points was by far the highest ever seen in a HCP Index. The 924 points in 2016 are even more impressive, particularly as the score criteria have been tightened for the EHCI 2017 in order to register differences.’ AEMH/FEMS - LISBON JUNE 7th 2018

EHCI 2017 But also some remarks: Direct access to specialist Infant deaths Cancer survival Alcohol (prevention) Physical activity (prevention) Novel cancer drugs deployment rate Access to new drugs AEMH/FEMS - LISBON JUNE 7th 2018

Biggest issues: - Pressure on labour market of doctors and supporting staff (many vacancies) - Technological innovations go too slow - Sick leave is increasing, partly due to high workload and too many hours of work - High administrative burden … and: Increasing of expenditure on healthcare as a result of an increase of demand for care  next slide AEMH/FEMS - LISBON JUNE 7th 2018

AEMH/FEMS - LISBON JUNE 7th 2018

But still The Netherlands is doing relatively well But still The Netherlands is doing relatively well! Source: JAMA, March 2018 Source: CBS AEMH/FEMS - LISBON JUNE 7th 2018

Pros and cons of the Dutch Healthcare system Pro: Solidarity of the system Accessible for everyone Efficient Increasing of costs appear to be stabilized Con: More focus on prevention is needed Threshold of direct access to Medical Specialist is the power of the system, but sometimes also the restriction AEMH/FEMS - LISBON JUNE 7th 2018