1. Designing a national health care performance system in the Netherlands: ZORGBALANS prof dr Gert Westert

2. Basics Ministry of Health Carefully assess the performance of the Dutch health care system Why performance /why now? -Lissabon 2000 agenda -EU market in 2010: strong and attractive -‘healthy’ public sector -Less input more output! Performance in terms of what? -Performance in terms of health OR in terms of health care -Health = f (…, Care) -Care = f (Quality, Access, Costs)

3. Performance framework for the Dutch healthcare, phase 1 Health performance of the system versus health care performance of the system ‘Steering the oil tanker’ Balanced score card: health system management (2003-2004) -Consumer -Financial -Internal processes -Innovation Cockpit signals: -26 baskets with indicators: -2 year interactive process

4. Performance framework for healthcare, phase 2 Health needs: 4x Change from BSC perspectives to system goals: quality, accesibility and costs OECD HCQI framework Baskets with indicators ‘adopted’ from phase 1 -Health impact -Susceptibility to being influenced by health care system -Policy importance Rearranged merging of baskets: -Q A €

5. Quality Effectiveness Patient- Centeredness (satis- faction, trust) Safety Innovativeness Access Choice Concentration Waiting Personell Cost for citizens Costs System costs Productivity Financial position suppliers Health care market Contracting

6. State of Dutch health care 2006/ ZORGBALANS 2006 Reference year 2004, published in April 2006 MACRO-level report 100 pages 15 chapters with 125 indicators and results Max. 5 key messages per chapter Executive summary describing the overall state, including trade-off issues for quality, access and costs Chapter on information needs for 2008 Zorgbalans team: 12 researchers Two examples: -Effectiveness cure -Waiting list in health care

7. Effectiveness of curative healthcare in the Netherlands is at best ‘average’ GP’s are not prescribing medications that should not be prescribed as recommended. GP’s refer less to hospitals that 15 year ago. Hospital-related mortality rates for pneumonia have been fluctuating around 10- 12% over the last several years. Hospital-related mortality rates for heart failure have also been stable with only slight improvements from 14% to 12% in the last 2 years. In-hospital AMI and stroke mortalities within 30 days of hospital admission are within the OECD average. Breast cancer mortality, which is improving slowly, is still high in the Netherlands compared to many other European countries. Five-year survival rates for cervical and colorectal cancers compare well to OECD averages. Asthma mortality is improving and is better than the OECD average. About 80% of all hip fractures are operated within 48 hours.

8. Number of people on a waiting list still considerable In 2003 218.000 were waiting on waiting list for health care Waiting list for hospital inpatient care simular as the year before (64,000 naar 62,500) Waiting list for mental health care increased slightly in the periode 2001- 2003 (14,100 naar 15,600) Waiting list in care much shorter (nursing homes from 11,400 to 6.900); home care from 39,600 to 19,500.

9. To conclude… JIGSAW PUZZLE of 1000 pieces, but we have only 100 pieces It is all about: Selection of indicators Representativeness Interpretation of results: norms and points of reference -Time and space comparisons -Within the Netherlands (benchmarking; small area variations; best practices) -International indicator sets: OECD (HCQI)