Wilt u weten hoe het gezicht van het Nederlandse zorgsysteem onderhouden en gevoed wordt? Ga dan naar de bron! Het World Economic Forum (WEF) heeft in samenwerking met het adviesbureau McKinsey & Company het onderstaande rapport uitgebracht: “A vision for the Dutch healthcare system in 2040”. Hieronder tref u de samenvatting. De volledige versie van het rapport kunt u hier bekijken en downloaden.
SUMMARY: A VISION FOR THE DUTCH HEALTH CARE SYSTEM IN 2040
TOWARDS A SUSTAINABLE, HIGH-QUALITY HEALTH CARE SYSTEM
A report from the World Economic Forum
Prepared in collaboration with McKinsey & Company
By 2040 the Netherlands will have educated a new generation of health care professionals who realize that the current increase in health care expenditure is no longer sustainable.
The system will reward doctors who select treatments which have sufficient effect in proportion to the costs.
In addition, a proportion of doctors have started to work in a more commercially minded manner. This group has concentrated on perfectly executing a limited set of treatments, instead of being a generalist or highly specialized. They will have been able to do this because processes will have been standardized and optimized. This will make the quality of these treatments among the best in the world.
Strategy 1: Concrete next steps
- Modify the education of doctors and other health care providers and offer appropriate training about;
- the purpose and use of quality indicators and evidence-based guidelines
- awareness of health care expenditure by offering and insight into the costs of treatment and diagnostics
- the role of a ‘care manager’’ in managing demand for care
- clinical leadership and the implementation of changes on the work floor
- Give a mandate to the Quality Institute, as independent and authoritative body (like NICE in the United Kingdom), to create clear standards an frameworks (for example, costs per QALY), with contributions from professional organizations and other stakeholders. Differentiate standards based on cost-benefit analyses for specific patient groups.
We’ve got to create the ‘’Bloomberg’ of the health care world to ensure we have the infrastructure, skills and methods to systematically record, analyze and use data to improve health care.
The majority of interviewees hope that doctors will for the most part be employed by a hospital.
Strategy 2: Concrete next steps
- Within a year, develop a clear set of quality indicators that are result-oriented wherever possible, as is the case in England and Sweden, and use them to:
- Support health care insurers in decisions about contracting health care institutions and the introduction of pay for performance components.
- Offer analysis data to health care providers and information to compile requirements for doctor accreditation.
- Enable the government and companies to offer clear quality-related information to patients.
- Invest in setting up data infrastructure – the Bloomberg of Health – and draw up the corresponding privacy legislation in order to use performance and quality-related data.
Consumer involvement in health care will have been further enhanced by government, insurers and health care providers having enable new models of ownership. A cooperative model, in which consumers are co-owner or supervisor of the health care providers, will have increased individual interest and involvement in the provision of good-quality health care at an affordable price.
Strategy 3: Concrete next steps
- Facilitate independence and responsibility among patients by offering an insight into personal Electronic Patient Files, medical files and the aforementioned quality information.
- Introduce (financial) incentives (rewards for healthy behavior, own contribution) in order to regulate the demand for health care.
Services that should not actually be covered by the health care insurance or which individuals can easily afford themselves, such as affordable antibiotic treatments, have been removed from the collective funds (with a safety net for those in genuine need). Health care insurers, pension funds and financial institutions will have developed ways in which private capital can be mobilized and utilized for funding health care.
A clear definition will exist for the threshold for including medicines and treatments in collective services, e.g. based on consensus with regard to the value for each ‘quality adjusted life year’ (QALY). This will also give pharmaceutical companies, equipment manufacturers and resource suppliers clarity in advance as to whether or not their products will be included in the basic insurance. Consequently, the industry will no longer view the development of advanced treatments as an end in itself but as one of the possible means to deliver better, cost-effective health care.
Strategy 7: Concrete next steps
- Develop a log-term vision for Dutch health care together with relevant health care stakeholders.
- Do not deviate from the long-term vision under pressure from lobby groups.
Will our political leadership be strong enough?
The changes to the system instigated by the introduction of the Health Insurance Act (‘ZVW’) in 2006, the abolition of the ex-post settlement of expenses for health insurance firms in 2012 and the recent changes to performance-based funding for hospitals requite time for the players in health care to adapt. In order to give the sector security and stability, political continuity will have to be offered by following the line of existing policy.
This does not alter the fact that political courage and leadership continue to be necessary: difficult decisions must be made over the next few years, which will be unpopular with the electorate, but which are necessary to keep health care expenditure under control. Examples of this are the curtailing of what is perceived to be an acquired right to the basic insurance package (cf. the famous example of the withdrawal of compensation for walking frames) and changes to and restrictions of long-term health care.
Another example involves the reorganization of the health care landscape, with more networks and greater differentiation in services offered. Health care providers will not be keen to consider themselves superfluous, but the power and influence of government and insurers has, to date, been somewhat limited on this front. It may be that mergers and moves towards partnership between hospitals could offer a solution, provided that the decisions made in this regard can be steered in the direction that offers the best balance for the overall range of services at nationwide or regional level.
Concrete next steps:
- Adapt the education of doctors and other health care providers.
- Give a mandate to the Quality Institute, as independent and authoritative body, to create clear standards and frameworks.
- Within a year, develop a clear set of quality indicators that are result-oriented.
- Invest in setting up data infrastructure – the Bloomberg of Health – and the accompanying privacy legislation.
- Make clear package choices for cure and care.
- Investigate the feasibility of alternative financing models for cure and care.
- Support specific downsizing or conversion of surplus capacity.
- Develop a long-term vision for Dutch health care together with relevant stakeholders.
- Do not deviate from the long-term vision under pressure from lobby groups.
‘What’ we want is less urgent than the question of ‘how’ we are going to get there.
We would like to offer special thanks to Mickey Schoch from the Ministry of Finance and Patrick Jeurissen from the Ministry of Health, Welfare and Sports for their help in preparing and executing this study.
The study was commissioned by the World Economic Forum and carried out free of charge by McKinsey & Company.
Johan van den Berg – Head Health, Welfare and Sport department, Ministry of Finance
Marcelis Boereboom – DG long-term Health care, Ministry of Health, Welfare and Sport
Lans Bovenberg – Deputy Crown-appointed member, Social-Economic Council
Jeroen van Breda Vriesman – Member Board of Directors, Achmea
Jak Dekker – Chairman, ZKN (independent Duth clinics)
Marc van Gelder – CEO Mediq
Frank de Grave – Chairman, Association of Medical Specialists
Rene Groot Koerkamp – Policy advisor Insurance, ZN
Patrick Jeurissen – Cluster coordinator Strategy and Knowledge, Ministry of Health, Welfare and Sport
Marcel Joacimsthal – Managing Director Netherlands, Glaxo Smithkline
Roelof Konterman – Director Health and Healthcare Division, Achmea
Rene Kuijten – Partner, Life Science Partners
Bert Kuipers – Corporate Director Public Affairs, Mediq
Theo Langejan – Chairman, NZa (Dutch health authority)
Emmo Meijer – Corporate Director R&D, Friesland Campina (Achmea Friesland verzekeringen)
Misja Mikkers – Director Strategy & Legal Affairs, NZa
Martin van Rijn – Secretary of State, Ministry of Health, Welfare and Sport (during the study: Chairman Board of Directors PGGM)
Michel van Schaik – Director Health Care, Rabobank
Mickie Schoch – Deputy head Bureau Strategic Analysis, Ministry of Finance
Paul Smit – Director, Agathellon/Former Sr VP Philips Healthcare
Theo van Uum – Director Financial Economic Affairs, Ministry of Health, Welfare and Sport
Helmer Vossers – Director Budgetary Affairs, Ministry of Finance
Loek Winter – Chairman Board of Directors – MC Groep and Professor Healthcare Entrepeneurship Nijenrode