Nederlands Huisartsen Genootschap Dutch College of General Practitioners Arno Timmermans, president

Dutch Health Care System Dual System General law on exceptional health care costs (27 %) long term treatments (nursing homes, long term semi permanent hospitalisation) disability costs Health Insurance (41 %) All essential health care, mandatory, universal coverage, private health insurers Additional optional health insurance packages (4%) Taxes (14 %) Out of pocket (9%) Others (4%)

Universal basic coverage Premium not related to health status or age Children under 18 free Compensation for low incomes Funding: 50 % employers 45 % insured person 5 % government Premium: approx. $130 a month (variation approx. 5%)

Primary Care in the Netherlands Most GPs self employed or working for another GP Patient list Gate keeper system Standard GP list 2350 Consultation rate 6/ year (consultations, telephone consultations, prescriptions) Combined: capitation fee and fee for service

Primary Care in the Netherlands GP Practice: GPs (most group practices, health centers, fewer single handed) Practice assistants Practice nurse (chronic care) Other primary care workers: Physiotherapists, dieticians, midwives, psychologists, district nurses, pharmacists

Best survey findings: costs as a barrier

Best Survey findings: visit to the emergency care

Best Survey findings: Diabetes HbA1c

Poor performance: coordination of care

Strategy : Improving collaboration GP´s/ medical specialists-hospital Strengthening the role of GPs/GP practices as coordinator of care