@TFHealthcare. Workshop. Health(care) in the Netherlands. International Visitors Programme PDF Free Download

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

09:00 Welcome by Moderator Peter Post, Director, Task Force Health Care 09:05 Welcome & Opening Angelique Berg, Director General, Ministry of Health, Welfare & Sport @TFHealthcare 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

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

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

Top the leagues?

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

How expensive is Dutch care? Health expenses EU member states (%GDP) A-typical growth pattern (% GDP) 12 11 10 9 8 7 6 1983 1988 1993 1998 2003 2008 2013 Netherlands European Average

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?

High use of longterm care Proportion population receiving formal LTC Per capita square meters in nursing homes 72 30 36 42 1983 1990 1997 2010

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

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: 194.000 (2009) to 20.000 (2016) 2. Switching: 3.6% (2006) to 7.3% (2015) 3. Avg. flat premium: 1226 (2012) t0 1203 (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)

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

Longterm care divided

Cost control 2012 2016: so far so good? Table: Forecasted and real average flat premium ( ) 06 07 08 09 10 11 12 13 14 15 16 Forecast 851 879 1057 1074 1085 1211 1222 1273 1226 1211 1243 Realization 771 848 1050 1059 1095 1199 1226 1213 1098 1158 1203 Difference 78 31 7 15-10 12-4 60 125 53 40 Increasing solvency (% total assets) Over(under) spending BKZ (mrd. )

Why has fiscal sustainability improved recently? Less growth in health expenses (2012 2016) 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

Also more financial risk by patients Voluntary deductible 11 12 13 14 15 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%

Less patients/clients and rapid growth capital investments Increasing volume of capital hospitals (1980 = 100) # patients and clients (1980 = 100) 2008 2009 2010 2011 2012 2013 polikliniek 405 400 403 408 384 393 (dag)opname 226 239 251 265 268 246 overig ziekenhuis 521 544 543 578 618 667 V&V zzp > 4 142 156 158 163 186 170 V&V uren 143 148 151 180 184 178 VG verblijf 170 181 181 189 195 194 VG dagbehandeling 589 561 529 529 523 502

Less patient volumes, an affordable solution? (Day) treatments per 1.000 inhabitants Per capita expenses pharmaceuticals

Active purchasing? Few changes in provider market shares

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% 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 AMC VU

Some conclusions Regulated competition and fiscal sustainability may align (2012-2016) 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

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

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

Thank you for your attention

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

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

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

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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

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 5-10-2017 35

The use of ehealth in the Netherlands

Interoperability in the Netherlands

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

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

Dutch ehealth challenge

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https://youtu.be/9xgzpsp6oso 5-10-2017 42

CBB HiX CBB CBB CBB CBB

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

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

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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

Garden of delights..

Thank you! Dr. Lies van Gennip @liesvangennip gennip@nictiz.nl 49

10:30 Coffee Break 10:45 Parallel Sessions ROOM 7.03 Public Health MAIN ROOM ehealth ROOM 7.04 Elderly Care @TFHealthcare 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

@TFHealthcare Thank you! Improving Healthcare Together

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