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Brief Introduction to the Health System of the Netherlands

Brief Introduction to the Health System of the Netherlands. 9 February 2011. Presentation by Bibiche Wymenga, Department of International Affairs.

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Brief Introduction to the Health System of the Netherlands

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  1. Brief Introduction to the Health System of the Netherlands 9 February 2011 Presentation by Bibiche Wymenga, Department of International Affairs

  2. Introduction: Health System?1. Health in The Netherlands2. The Ministry of Health, Welfare & Sport3. From former to current health system4. Facing the challenges: Policy strategy

  3. Introduction: Health System?

  4. The condensed version:Health Care System since 2006 For in depth background: Health Systems in Transition Report 2010 (on USB-stick)

  5. 1. Health in The Netherlands

  6. 16,7 million inhabitants • 100 hospitals • 16000 medical specialists • 8000 general practitioners • 21 insurance companies • € 63 billion spent on health • care = 10% GDP

  7. Challenges: Top 10 diseases in the Netherlands Mortality Lost Years of Life Burden (DALY’s) 1 Coronary Heart Disease Lung Cancer Lung Cancer 2 Lung Cancer Coronary Heart Disease Depression 3 Stroke Stroke Stroke 4 Dementia Colon Cancer Anxiety Disorder 5 Heart Failure Respiratory COPD Diabetes 6 Respiratory COPD Breast Cancer Lung Cancer 7 Pneumonia Heart Failure Respiratory COPD 8 Colon Cancer Dementia Arthrosis 9 Diabetes Self-inflicted Injury Accidents 10 Breast Cancer Pneumonia Dementia (Source: VTV Public Health Forecast 2010, National Institute for Public Health & the Environment (RIVM))

  8. 2. The Ministry of Health, Welfare & Sport

  9. Minister • Ms. 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 Secretary • Ms. Marlies Veldhuijzen van Zanten - Hyllner • Portfolio • Long-Term Care • Social Support • Youth Care, Elderly Care • Disability Care • Biotechnology & Research Secretary General Deputy SG A. Kleinmeulman G. van Maanen DG Public Health DG General Health Care DG Youth & Social Care DG Long-term Care P. Huijts L. van Halder M. Boereboom M. van Gastel • Dept. Public Health • Dept. Nutrition, Protection and • Prevention • Dept. Sports • Dept. Health Care • Dept. Medicines & Medical • Technology • Dept. Market & Consumer • Long-Term Care Dept. • Health Insurance Dept. • Macroeconomic Issues & • Employment Conditions Dept. • Social Support Department • WW II Victims Remembrance Unit • Youth Care Department • Youth & Families Programme 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.

  10. AGENCIES WITHIN THE MINISTRY • (3500 employees) • INDEPENDENT GOVERNMENTAL BODIES • (600 employees) • 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)

  11. 3. From former to current health system

  12. Characteristics of the Dutch Health Care system • Tradition of private initiative • Hospitals, nursery homes are privately owned • Medical specialists and general practitioners are mostly private entrepreneurs • Former health insurance system • 60% 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 containment • Detailed price regulation, budgeting • National & regional planning & licensing

  13. Pros & cons of the former system • Pros • Cost containment on macro (national) level • Policy implementation through intervening in the system • Quality (of health care delivery) • Cons • Macro efficiency, micro inefficiency • Lack of spirit of enterprise & innovative climate • Rationing → waiting lists • Growing pressure on the system • Demographics (ageing & labor market) • Technology developments • Law suits because of waiting lists !

  14. Compulsory insurance (consumers) • Open enrolment (insurer) • Legally defined coverage (insurer) • No premium differentiation (insurer) • Submission to risk adjustment (insurer) • Income related contribution (consumer) Managed competition • 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 Health Insurance Act Equity Sickness funds (2/3) Private insurance (1/3) Efficiency Public Insurance Civil servants

  15. 4. Facing the challenges: Policy strategy

  16. How to build a sustainable health care system? • Fair share of solidarity • High responsiveness to change • Efficiency seeking

  17. 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

  18. New government, new policy priorities • Published end of January 2011: • Strategic policy document Minister • Strategic policy document State Secretary

  19. Health care and sports nearby Carefulnessclose to home Basic care close to home 1 1 Municipalities facilitate easy access to youth care and social assistance Sports in your neighbourhood 2 2 Tailored care with affection Value and quality for your money Sustainablecareand social assistance Pay for performance 3 Organisation of long term care and youth care in order 3 More quality, safety and transparency 4 4 Appreciation for good quality and continuous improvement The right professional in the right place 5 5 More quality Opportunities for people and entrepreneurs People makes care More freedom of choice 6 6 Empowerment Autonomy of decision on lifestyle choices 7 7 Zero tolerance ofdependency abuse More dynamics in health care Trust in care More freedom and accountability for health care providers 8 8 Appreciation for professionals Simplification and reduction of administrative burden 9 9 Reciprocity between client and professional

  20. 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/

  21. Thank you for your attention.

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