@TFHealthcare. Workshop. Health(care) in the Netherlands. International Visitors Programme 2017

Transcription

1 Health(care) in the Netherlands International Visitors Programme 2017

2 09:00 Welcome by Moderator Peter Post, Director, Task Force Health Care 09:05 Welcome & Opening Angelique Berg, Director General, Ministry of Health, Welfare & 09:15 The Dutch Health(care) System: Accessibility, Quality & Affordability Prof. Dr. Patrick Jeurissen, Chief Research Scientist, Ministry of Health, Welfare & Sport 10:00 ehealth in the Netherlands Lies van Gennip, Director, Nictiz (National Competence Centre for Standardisation & ehealth) 10:30 Coffee Break Agenda 10:45 Parallel Sessions 12:00 Networking Lunch 13:00 End

3 热烈欢迎 Sawubona Gorąco witamy Herzliches Willkommen Warm Muito bem-vinda Добро дошли Karibu sana ترحيب حار Fàilte

4 09:00 Welcome by Moderator Peter Post, Director, Task Force Health Care 09:05 Welcome & Opening Angelique Berg, Director General, Ministry of Health, Welfare & 09:15 The Dutch Health(care) System: Accessibility, Quality & Affordability Prof. Dr. Patrick Jeurissen, Chief Research Scientist, Ministry of Health, Welfare & Sport 10:00 ehealth in the Netherlands Lies van Gennip, Director, Nictiz (National Competence Centre for Standardisation & ehealth) 10:30 Coffee Break Agenda 10:45 Parallel Sessions 12:00 Networking Lunch 13:00 End

5 Going Dutch? If context is not transferrable what remains? Prof. dr. Patrick Jeurissen

6 Top the leagues?

7 The Netherlands: Average health (Healthy) live expectancy Female smokers SE IT NL

8 How expensive is Dutch care? Health expenses EU member states (%GDP) A-typical growth pattern (% GDP) Netherlands European Average

9 Understanding the context of Dutch healthcare: institutional constraints that withstood reforms Maximizing risk-solidarity (OUP expenses; benefit basket; risk-adjustment; egalitarian health outcomes; community rating; open enrolment) Gatekeeper is the family physician (increases risk-solidarity) Self-employed hospital doctors (exception university clinics) Large general acute-care nonprofit hospitals; care normally around-thecorner High penetration tertiary care, very high research outputs Average hospital care sector; large long-term care sector Stewardship: consensus-based governance model Low volumes, high prices?

10 High use of longterm care Proportion population receiving formal LTC Per capita square meters in nursing homes

11 Stewardship MOH: system MOF: global budget Agencies Independent Central bank Competition authority Central economic bureau Arms-length Health market authority Healthcare Institute Inspectorates Patient safety Fraud and abuse Going Dutch? Reforms at work? Semi-private governance Social-economic council Covenants: building coalitions Credit enhancement Professional standards Interest groups (Higher) productivity Provider innovation Open enrolment & universal coverage Corrective governance mechanisms Hospitals Multiple payers (Selective) purchasing 1. Community rating 2. Deductible 3. Subsidies for lower incomes 4. 50% payroll tax 1. Solvency setting 2. Risk adjustment 3. Group contracts 4. Indemnity / Managed care 1. VBID 2. Selective purchasing / P4P 3. Free rates (70%) 4. Quality indicators 1. Independent non-state facilities 2. Free investments (>90%) 3. State-of-the-art quality 4. (Self-employed) physicians 5. Free-provider-choice

12 Assessment: ten years market reforms 1. Hospital productivity: 2.5% 2. Avg. length-of-stay: 7.9 (2002) to 4.7 (2010) 3. No waiting lists 1. ASC: 37 (2006) to 176 (2011) 2. FP Hospitals: 2 (2009) 3. Outpatient clinics: 61 (2009) to 112 (2014) (Higher) productivity Provider innovation Open enrolment & universal coverage Corrective governance mechanisms Hospitals 1. Uninsured: (2009) to (2016) 2. Switching: 3.6% (2006) to 7.3% (2015) 3. Avg. flat premium: 1226 (2012) t (2016) Multiple payers (Selective) purchasing 1. Solvency: 17% (2006) to 27% (2014) 2. Overhead: 4.5% (2006) to 3.2% (2014) 3. Groups: 55% (2006) to 69% (2012) 4. Some mergers 1. Few changes market share (3%) 2. Volume caps and budgets (>90%) 3. Few price conversions 1. Solvency: 9.1% (2004) to 21.5% (2015) 2. Overhead: 19.79% (2011) 3. Price increases 2006 to 2009: 9.5% (A) and 4.8% (B) 4. # Hospitals: 99 (2005), 84 (2014)

13 Diffusive policy paradigms in LTC New services Core residential Universal How to assess clients? Target groups Client demands Fixed provisions

14 Longterm care divided

15 Cost control : so far so good? Table: Forecasted and real average flat premium ( ) Forecast Realization Difference Increasing solvency (% total assets) Over(under) spending BKZ (mrd. )

16 Why has fiscal sustainability improved recently? Less growth in health expenses ( ) 1. increase deductible, abolishing certain financial compensations for chronically ill 2. risk-bearing insurance companies 3. national covenants (to limit growth in expenses) Ending risk equalization 4. limiting budgets for long-term care 5. devolving services to municipalities

17 Also more financial risk by patients Voluntary deductible none 94% 93,1% 90,3% 89% 88% 100 1,4% 1,4% 1,4% 1,4% 1,4% 200 0,9% 0,9% 1,1% 1,3% 1,3% 300 0,8% 0,9% 0,7% 8% 0,7% 400 0,1% 0,1% 0,2% 0,2% 0,2% 500 2,7% 3,6% 6,2% 7,3% 8,3%

18 Less patients/clients and rapid growth capital investments Increasing volume of capital hospitals (1980 = 100) # patients and clients (1980 = 100) polikliniek (dag)opname overig ziekenhuis V&V zzp > V&V uren VG verblijf VG dagbehandeling

19 Less patient volumes, an affordable solution? (Day) treatments per inhabitants Per capita expenses pharmaceuticals

20 Active purchasing? Few changes in provider market shares

21 Active purchasing in vitro fertalization? 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Succesrate (5-year average) Marketshare Amsterdam 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% AMC VU

22 Some conclusions Regulated competition and fiscal sustainability may align ( ) Be hesitant with incentives that only target lower volumes Increases in technical efficiency (less waste) more important than increases in co-payments or benefit reductions Efficiency: steering on best-practices Aligning trends in epidemiology/technology and budgetary policy Possibilities for fiscal enforcement are needed (MBI) Do not disturb intrinsic motivation by professionals

23 What makes a healthcare system sustainable? Good performance on 1) access, 2) quality, 3) efficiency, affordability No golden bullets from a health system perspective (OECD, 2010) & very difficult to change context by policy reforms Powers for endogenous improvements more important: 1) To innovate along the lines of value/efficiency 2) To correct for value destroying behaviours

24 What works according the review peer-reviewed literature, systematic review

25 Thank you for your attention

26 09:00 Welcome by Moderator Peter Post, Director, Task Force Health Care 09:05 Welcome & Opening Angelique Berg, Director General, Ministry of Health, Welfare & 09:15 The Dutch Health(care) System: Accessibility, Quality & Affordability Prof. Dr. Patrick Jeurissen, Chief Research Scientist, Ministry of Health, Welfare & Sport 10:00 ehealth in the Netherlands Lies van Gennip, Director, Nictiz (National Competence Centre for Standardisation & ehealth) 10:30 Coffee Break Agenda 10:45 Parallel Sessions 12:00 Networking Lunch 13:00 End

27 eheath in the Netherlands Lies van Gennip, PhD CEO of Nictiz: National competence centre for ehealth

28 This presentation Health care system The Netherlands Nictiz How digital is Dutch health care? Two cases: Empowering patients Re-using clinical data for quality

29 - Relatively high High quality healthcare According to various international investigations Well-organised primary care (GP s) Contributing to quality

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32 Nictiz: national competence centre for ehealth Founded in 2002 Foundation without commercial purpose Information standards for health care, advice on ehealth policy, support ehealth implementation ~50 people Financing: mainly ministry of health, welfare and sports Not: development of technological solutions or infrastructure(s) 34

33 Partner in national programs For development and implementation Of standards Centre of expertise and advisor for government and healthcare field Access point and Keeper of Information standards And terminology

34 The use of ehealth in the Netherlands

35 Interoperability in the Netherlands

36 PWC (2014) European Hospital Survey. Benchmarking Deployment of ehealth services 38

37 Dutch ehealth challenges The empowered patient that needs to know and enrich his medical information Continuity of care, as patients deal with multiple health care providers Closing the quality loop: knowing, understanding and managing health care better Need for interoperability, standards, in practice

38 Dutch ehealth challenge

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41 CBB HiX CBB CBB CBB CBB

42 HiX CBB For the patient and the doctor? National Register For prostheses No more paper handling No more retyping Re-use of data results in Correct data for quality register

43 HiX ZIB The Orthopedic Surgeons response: This makes me happy, this is

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45 Challenges Balancing act between bottom up vs top down Capture the value of fast growing technology in slowly changing organizations Managing expectations and short term benefits; the better is the enemy of the good. The asymmetric business case of healthcare

46 Garden of delights..

47 Thank you! Dr. Lies van 49

48 10:30 Coffee Break 10:45 Parallel Sessions ROOM 7.03 Public Health MAIN ROOM ehealth ROOM 7.04 Elderly Evidence-based Public Health Mariken Leurs, National Institute for Public Health and Environment ehealth Policy Ron Roozendaal, Chief Information Officer, Ministry of Health, Welfare & Sport Elderly care in the Netherlands Martin Holling, Ministry of Health Welfare & Sport Quality of Care: Dutch Institute for Clinical Auditing (DICA) Wim Smit, Value2Health Go-FAIR & Personal Health Train Erik Schultes, Dutch Techcentre for Life Sciences Privacy & Innovation Michaël Stekkinger, MRDM From PPP to innovation: Fall Prevention Project TOM By Nutricia, Veiligheid NL & Philips Kenya Poland South Africa Serbia Germany United States U.A.E. Brazil China Simultaneous translation English Chinese 12:00 Networking Lunch 13:00 End

49 @TFHealthcare Thank you! Improving Healthcare Together