Dutch Orthopaedic Surgery

1. Dutch Orthopaedic Surgery Introduction of the country and the specialty

2. The Netherlands • On Saturday 13th of October: 16.385.486 inhabitants, 484 / km2 • Growing with average 80 persons per day, birth 515, death 375, net immigration -75 • Contact family doctor per year 75% - 72% • Contact specialist per year 37% - 40% Frank van Oosterhout, UEMS, Toulouse 2007

3. Age and mix of population • “Green demographic pressure” lowered from 68% to 40 % (ages 0 -20 / 20-65) • “Grey demographic pressure” rose from 14 % to 24 % (ages over 65 / 20-65) • Immigrants, “non Dutch”, all generations, 3.170.406 is 19 % of the population Frank van Oosterhout, UEMS, Toulouse 2007

4. Number of Hospitals • 8 University Hospitals • 88 General Hospitals • 9 Specialised Hospitals • 51.000 hospital beds incl. day-care • 247.000 employees excl. private practice medical specialists • 7000 medical specialist in private practice Frank van Oosterhout, UEMS, Toulouse 2007

5. Risk Management • On 1st January 2008 all Dutch hospitals must have a risk management system, not only on medical risks but also on general risks for example fire risks, even financial risks and a system of blame free reporting • Corporate governance becomes for hospitals as usual as it is for companies Frank van Oosterhout, UEMS, Toulouse 2007

6. Orthopaedic surgery • Dutch Orthopaedic Association • 770 members, 470 active surgeons, 3 non member orthopaedic surgeons. • 3 general meetings each year, 2 of two days and 1 of one day • Main meeting every year in another city, main topic, sometimes together with neurosurgeons, plastic surgeons or traumatologists Frank van Oosterhout, UEMS, Toulouse 2007

7. Dutch Orthopaedic Ass. (1) • DOA (NOV) is full member of the NOF • DOA-BVOT meeting every two year • DOA full member of B&J Decade • DOA and subspecialty groups on traumatology, pediatrics, implants, arthroscopy, spinal, foot - ankle and shoulder - elbow Frank van Oosterhout, UEMS, Toulouse 2007

8. Dutch Orthopaedic Ass. (2) • Working groups on training and education • Working group on scientific work • Working group on disability evaluation • Working group on business aspects • Working groups on patient education, communication, website, professional and product quality. Frank van Oosterhout, UEMS, Toulouse 2007

9. Working Environment • Private practice 65 %, employee 32 % • General hosp. 46 %, training hosp. 29 % • University hosp. 18 %, • One specialised hospital with 13 OS • Several private clinics • 87 % calls itself fulltime with 52.2 as a mean number of working hours / week Frank van Oosterhout, UEMS, Toulouse 2007

10. “Orthopaedic Performance” • 220.000 operations, 224.000 admissions • 34.500 meniscal excisions • 19.400 knee implants • 22.400 total hip arthroplasties • 2.300 spondylodeses • 10.600 intervertebral excisions Frank van Oosterhout, UEMS, Toulouse 2007

11. Professional Quality • The D.O.A and its system of quality control • Peer to peer visits every five years, if needed more frequent • Report of the visit is confidential, the result is not • Quality visit is mandatory for continuation of individual registration as medical specialist Frank van Oosterhout, UEMS, Toulouse 2007

12. Product Quality (1) • General Hospital Performance Indicators • Indicators on system, process and few on outcome • For orthopaedic surgery: time between admission and operation in hip fracture patients • Also: systematic registration of complications Frank van Oosterhout, UEMS, Toulouse 2007

13. Product Quality (2) • New indicators, especially on orthopaedic surgery, next year mandatory • Insisted on by health insurance companies and patient organisations • Complication registration, implant registration, DVT prophylaxis, infection prophylaxis, patient education for hip and knee surgery Frank van Oosterhout, UEMS, Toulouse 2007

14. Implant Registration • The Dutch Orthopaedic Implant register almost died ten years ago because of lack of financial air • With the new DBC (=DRG look alike) system resuscitation started, money infusion • This year, 11 hospitals start over with a new system, developed by the Leiden University Orthopaedic Clinic Frank van Oosterhout, UEMS, Toulouse 2007

15. Healthcare finance (1) • All inhabitants have a health care insurance • There are seven 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 Frank van Oosterhout, UEMS, Toulouse 2007

16. Healthcare finance (2) • Private paractice orthopaedic surgeons are paid by fee for service in a DRG look alike system, called DBC • Hospitals are paid in a complicated budget system based on historical out clinic, clinic and day care production plus some other parameters • These two systems are not always compliant Frank van Oosterhout, UEMS, Toulouse 2007

17. 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 • Within years hospitals will issue stocks and pay there investors, or will be bought and sold by investors • Will medical specialist become stockholders of the hospitals? Frank van Oosterhout, UEMS, Toulouse 2007