DUTCH ORTHOPAEDIC SURGERY INTRODUCTION OF THE COUNTRY AND THE SPECIALTY

DUTCH ORTHOPAEDIC SURGERY INTRODUCTION OF THE COUNTRY AND THE SPECIALTY

2 THE NETHERLANDS On Sunday 23th of September: 16.743.640 inhabitants, 1 out of 8 non Dutch origin Expenditure on healthcare rose from 8 to 13 % of g.n.p. Expenditure includes cure and care 37% (2005) - 45% (2010) contacted a medical specialist per year

3 NUMBER OF HOSPITALS AND MORE 8 University Hospitals 76 General Hospitals 23 Specialised Hospitals, 1 orthopaedic 50.000 hospital beds incl. day-care 1,4 million people work in cure and care 7000 medical specialists in private practice Private to employed is 2 to 1 with employed growing Private in the general hospitals looks like employed

4 ORTHOPAEDIC SURGERY Dutch Orthopaedic Association 1270 members, 691 active surgeons, 3 non member orthopaedic surgeons, around 15 foreign members and around 15 Dutch members working abroad 3 general meetings per year, 2 of two days and 1 of one day Main meeting January, every year in another city, main topic Sometimes together with neurosurgeons, plastic surgeons or traumatologists

5 DUTCH ORTHOPAEDIC ASSOCIATION DOA (NOV) is full member of the NOF Standing committees on quality, science, training and syndicat DOA and subspecialty groups on trauma, pediatrics, hip, knee, arthroscopy, spinal, foot - ankle and shoulder elbow, biotechnology

6 ORTHOPAEDIC TRAINING Training is 1.5/4.5 years along CanMeds competencies At least one year in University Hospital and at least one year in a peripheral training hospital Yearly compulsory exams, no final exam CAT s, critical appraised topics OSB s, orthopaedic standard treatment Complete portfolio/logbook

7 WORKING ENVIRONMENT Private practice 65 %, employee 32 % General hosp. 46 %, training hosp. 29 % University hosp. 18 %, always employees One specialised hospital with 17 OS 8 real private orthopedic clinics 87 % calls itself fulltime with 52.2 as a mean number of working hours / week

8 ORTHOPAEDIC PERFORMANCE 27.000 total hip arthroplasties (2009) costing 227.000.000 cure euro s 19.000 knee implants (2010) costing 177.000.000 cure euro s Growth expected to 32.000 hips and 22.000 knees in 2030 According to a study of one of the biggest health insurance companies and based on invoice data

9 PROFESSIONAL QUALITY The D.O.A and its system of quality control Quality visitations every five years, if needed more frequent Report of the visit is confidential, the result is not, the report goes also to the hospital board Quality visit is mandatory for continuation of individual registration as medical specialist

10 PRODUCT QUALITY (1) General Hospital Performance Indicators Indicators on system, process and some on outcome For orthopaedic surgery: re operation rate in hip fracture patients, point prevalence of pressure sores in THA patients Also: systematic registration of complications, numbers of patients complying to some nationwide guidelines

11 PRODUCT QUALITY (2) PROM s on hip (and knee) replacement will be advised (2012) Insisted on by health insurance companies and patient organisations to compare hospitals and surgeons Indicators on complication registration, implant registration, DVT prophylaxis, infection prophylaxis, patient education for hip and knee surgery DOA volume related quality indicators will be published with minimum numbers of interventions per hospital (2012)

12 HEALTHCARE FINANCE (1) All inhabitants have a health care insurance There are six insurance companies in a competitive market They all have to offer a basic insurance package for a standardised set of health care services, so they can only compete on price and company service They try to compete on quality of cure the be contracted The role of the insurance companies becomes more and more important

13 HEALTHCARE FINANCE (2) Private practice orthopaedic surgeons are paid by fee for service in a DRG look alike system, called DOT Hospitals were paid in a complicated budget system based on historical out clinic, clinic and day care production plus some other parameters These two systems are mixed now to pay hospitals on DOT base as well

14 HEALTHCARE FINANCE (3) Not only the insurance companies but also the hospitals and medical specialists arrive in a competitive market with a government disappearing to a background role of control? Within years hospitals will issue stocks and pay the profit to there investors, or will be bought and sold by investors? In last elections one of the winning parties, Labour, said to stop this development

15 THE DUTCH GENERAL PRACTITIONER They were paid on subscription base, for every member of the practice an amount of money Now more and more paid on fee for service, for every intervention an amount of money The meaning is to keep patients as long as possible in the first line

16 THE DUTCH TRAUMA CARE Done by general surgeons certificated to do so on historical base Done by trauma surgeons trained to do so Done by orthopedic surgeons certificated by being member of the Dutch Association for Orthopedic Traumatology The pattern can change form hospital to hospital There exists a convenant that every orthopedic practice can claim 20% of the trauma care in its hospital