Primary Care as a Window into a High Performance Health Care System I

Primary Health Care in The Netherlands - relic of the 20th or saviour of the 21th century - Niek Klazinga Dept Social Medicine Dept Social Medicine Why The Netherlands might be of interest for the USA • private insurers • private practice • mandatory health insurance for all citizens • strong primary health care system Dept Social Medicine Dept Social Medicine Health insurance in The Netherlands • regulated private insurance market since 2006 • mandatory basic insurance • mandatory acceptance • voluntary supplementary insurance • nominal competitive premiums • contribution via employer • tax-based health care subsidy for persons with a low income • risk-equalization fund Dept Social Medicine Primary Care in The Netherlands • 8000 GP’s (13.000 specialists) • average practice 2400 persons • broad professional profile • registered patients • gate-keeper function • solo, duo, group-practices • pharmacists, midwives, allied-health professionals • complementary public health system at level municipalities Dept Social Medicine Quality assurance of GP care • • • • • GP training, CME, visitation, re-registration National guideline programme NHG Peer-review activities Practice evaluation Emerging systems of indicators and P4P Dept Social Medicine Dept Social Medicine Dept Social Medicine Dept Social Medicine Dept Social Medicine Relic? • eroding gate keeper function (occupational medicine, youth medicine, nursing home physician) • outsourcing out-of-hours care • less psycho-social care • delayed organizational upscaling • labour market shortages • ownership shifting to other providers and insurers Dept Social Medicine Saviour? • embedding prevention function in primary health care • embedding long term care in primary health care Dept Social Medicine • well developed information infrastructure • high level of professionalization GP’s • well developed quality policies • initiatives with task substitution and new professions • experimentation with organizational models • linkages with public health, long-term care and hospital care • preferences patients and insurers • potential for benchmarking Dept Social Medicine Dept Social Medicine