brief introduction to the health system of the netherlands presentation by bibiche wymenga,...
TRANSCRIPT
Brief Introduction to the Health System of the Netherlands
Presentation by Bibiche Wymenga,Department of International Affairs
9 February 2011
Introduction: Health System?
1. Health in The Netherlands
2. The Ministry of Health, Welfare & Sport
3. From former to current health system
4. Facing the challenges: Policy strategy
Introduction: Health System?
The condensed version:Health Care System since 2006
For in depth background: Health Systems in Transition Report 2010 (on USB-stick)
1. Health in The Netherlands
• 16,7 million inhabitants
• 100 hospitals
• 16000 medical specialists
• 8000 general practitioners
• 21 insurance companies
• € 63 billion spent on health
care = 10% GDP
Challenges: Top 10 diseases in the Netherlands
(Source: VTV Public Health Forecast 2010, National Institute for Public Health & the Environment (RIVM))
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1
DementiaPneumoniaBreast Cancer
AccidentsSelf-inflicted InjuryDiabetes
ArthrosisDementiaColon Cancer
Respiratory COPDHeart FailurePneumonia
Lung CancerBreast CancerRespiratory COPD
DiabetesRespiratory COPDHeart Failure
Anxiety DisorderColon CancerDementia
StrokeStrokeStroke
DepressionCoronary Heart DiseaseLung Cancer
Lung CancerLung CancerCoronary Heart Disease
Burden (DALY’s)Lost Years of LifeMortality
2. The Ministry of Health, Welfare & Sport
Policy department:• International Affairs Dept.
Advisory and support departments:• Financial & Economic Affairs Dept.• Operational Management Dept.• Legislation & Legal Affairs Dept.• Personnel & Organisation Dept.• Information & Communication Dept.• Management Support Dept.
A. Kleinmeulman
Deputy SGSecretary General
G. van Maanen
DG General Health Care
L. van Halder
• Dept. Health Care• Dept. Medicines & Medical Technology• Dept. Market & Consumer
DG Long-term Care
M. Boereboom
• Long-Term Care Dept. • Health Insurance Dept. • Macroeconomic Issues & Employment Conditions Dept.
DG Youth & Social Care
M. van Gastel
• Social Support Department• WW II Victims Remembrance Unit• Youth Care Department• Youth & Families Programme
MinisterMs. Edith Schippers
Portfolio• Financial Policy & Administration• Health Care & Public Health• Infectious Disease Control• Pharmaceuticals & Devices• Markets, Quality, Consumers• Sport• Innovation & Technology• Education, Labour Market, Ethics• Agencies & Inspections
State SecretaryMs. Marlies Veldhuijzen van Zanten - Hyllner
Portfolio• Long-Term Care• Social Support• Youth Care, Elderly Care• Disability Care• Biotechnology & Research
DG Public Health
• Dept. Public Health• Dept. Nutrition, Protection and Prevention• Dept. Sports
P. Huijts
Ministry of Health, Welfare & Sport
Health Care Inspectorate (IGZ)
RIVM - National Institute for Public Health and the Environment (including Centre for Infectious Disease Control)
Netherlands Vaccine Institute (NVI)
Food and Consumer Product Safety Authority (VWA)
Health Council (GR)
Social Cultural Planning Office (SCP)
Central Information Unit on Health Care Professions (CIBG)
Health Care Authority (NZA)
Health Care Insurance Board (CVZ)
Medicines Evaluation Board
• Netherlands Organization for Health Research and Development (ZonMW)
Stichting Fonds PGO (funding for national patient & disability organizations and senior citizens’associations)
AGENCIES WITHIN THE MINISTRY(3500 employees)
INDEPENDENT GOVERNMENTAL BODIES(600 employees)
3. From former to current health system
Characteristics of the Dutch Health Care system
•Tradition of private initiativeHospitals, nursery homes are privately ownedMedical specialists and general practitioners are mostly private entrepreneurs
•Former health insurance system60% social insurance (below average income level)30% private insurance (no government interference)10% civil servants, elderly etc.
•Growing government interference (from ± 1980 onwards)
Main objective: cost containmentDetailed price regulation, budgeting National & regional planning & licensing
Pros & cons of the former system
•Pros Cost containment on macro (national) levelPolicy implementation through intervening in the systemQuality (of health care delivery)
•ConsMacro efficiency, micro inefficiencyLack of spirit of enterprise & innovative climateRationing → waiting lists
•Growing pressure on the systemDemographics (ageing & labor market)Technology developmentsLaw suits because of waiting lists !
Public InsuranceCivil servants
Private insurance (1/3)
Sicknessfunds (2/3)
Health Insurance
Act
• Compulsory insurance (consumers)• Open enrolment (insurer)• Legally defined coverage (insurer)• No premium differentiation (insurer)• Submission to risk adjustment (insurer)• Income related contribution (consumer)
• Compulsory deductible (consumers)• Free to set nominal premium (insurer) • Free to offer different policies (insurer)• Free to offer suppl. deductible (insurer) • Free to engage group contracts (insurer)
The insurance reform 2006
Managed competition
Equity
Efficiency
4. Facing the challenges: Policy strategy
How to build a sustainable health care system?
• Fair share of solidarity
• High responsiveness to change
• Efficiency seeking
Coalition agreement (30/09/10)
•Move ahead!- increase free pricing- increase amount of risk bearing- allow for private capital•Health care is only sector with significant growth•Integrated care nearby: doctor around the corner•Coverage shrinking (lower disease burden)•More copayments •Establish Health Care Quality Institute
New government, new policy priorities
Published end of January 2011:
-Strategic policy document Minister -Strategic policy document State Secretary
Sustainablecare
and socialassistance
Carefulnessclose to home
People makes care
Zero tolerance ofdependency abuse
Empowerment
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Appreciation for professionals8
Reciprocity between client and professional9
Appreciation for good quality and continuous improvement
Organisation of long term care and youth care in order
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More quality5
Tailored care with affection
Municipalities facilitate easy access to youth care and social assistance
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Value and quality for
your money
Health care and sports
nearby
Opportunities for people
andentrepreneurs
Autonomy of decision on lifestyle choices
More freedom of choice
More freedom and accountability for health care providers
Simplification and reduction of administrative burden
More quality, safety and transparency
Pay for performance
The right professional in the right place
Sports in your neighbourhood
Basic care close to home
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Trust in care
More dynamics
in health care
Additional information is available on USB-stick:
Health Care Systems in Transition Report of 2010 by the European Observatory on Health Systems
Dutch Health Care Performance Report 2010 by the National Institute of Public Health and the Environment (2010)
Legal Framework – the basis of the 2006 Health System Reform
Links to health policy and system research publications:
• Nivel – Netherlands Institute for Health Services research http://www.nivel.eu/
• National Institute of Public Health & the Environment http://www.rivm.nl/en/
• Netherlands Organisation for Health Research & Development http://www.zonmw.nl/en/
Thank you for your attention.