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Brief Introduction to the Health System of the Netherlands 9 February 2011 Presentation by Bibiche Wymenga, Department of International Affairs 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 Mortality Lost Years of Life Burden (DALY’s) 1 Coronary Heart Lung Cancer Lung Cancer Disease 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)) 2. The Ministry of Health, Welfare & Sport Ministry of Health, Welfare & Sport Minister Ms. Edith Schippers State Secretary Portfolio • Financial Policy & Administration Ms. Marlies • Health Care & Public Health Veldhuijzen van • Infectious Disease Control Zanten - Hyllner • Pharmaceuticals & Devices • Markets, Quality, Consumers Portfolio • Sport • Long-Term Care • Innovation & Technology • Social Support • Youth Care, Elderly Care • Education, Labour Market, Ethics • Disability Care • Agencies & Inspections • Biotechnology & Research Policy department: Secretary General Deputy SG • International Affairs Dept. Advisory and support departments: • Financial & Economic Affairs Dept. G. van Maanen A. Kleinmeulman • Operational Management Dept. • Legislation & Legal Affairs Dept. • Personnel & Organisation Dept. • Information & Communication Dept. • Management Support Dept. DG Public Health DG General Health Care DG Long-term Care DG Youth & Social Care P. Huijts L. van Halder M. Boereboom M. van Gastel • Dept. Public Health • Dept. Health Care • Long-Term Care Dept. • Social Support Department • Dept. Nutrition, Protection and • Dept. Medicines & Medical • Health Insurance Dept. • WW II Victims Remembrance Unit Prevention Technology • Macroeconomic Issues & • Youth Care Department • Dept. Sports • Dept. Market & Consumer Employment Conditions Dept. • Youth & Families Programme AGENCIES WITHIN THE MINISTRY INDEPENDENT GOVERNMENTAL BODIES (3500 employees) (600 employees) Health Care Inspectorate (IGZ) Health Care Authority (NZA) RIVM - National Institute for Public Health and Health Care Insurance Board (CVZ) the Environment (including Centre for Infectious Disease Control) Medicines Evaluation Board Netherlands Vaccine Institute (NVI) • Netherlands Organization for Health Food and Consumer Product Safety Authority Research and Development (ZonMW) (VWA) Stichting Fonds PGO (funding for national Health Council (GR) patient & disability organizations and senior citizens’associations) Social Cultural Planning Office (SCP) Central Information Unit on Health Care Professions (CIBG) 3. From former to current health system 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 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 ! The insurance reform 2006 • Compulsory insurance (consumers) • Open enrolment (insurer) Equity Sickness • Legally defined coverage (insurer) funds (2/3) • No premium differentiation (insurer) • Submission to risk adjustment (insurer) Health • Income related contribution (consumer) Insurance Private insurance (1/3) Managed competition Act • Compulsory deductible (consumers) • Free to set nominal premium (insurer) Public Insurance Efficiency Civil servants • Free to offer different policies (insurer) • Free to offer suppl. deductible (insurer) • Free to engage group contracts (insurer) 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 Municipalities facilitate easy access Basic care close to home 1 Health care 1 to youth care and social assistance Carefulness and sports close to home nearby Sports in your neighbourhood Tailored care with affection 2 2 Organisation of long term care Pay for performance 3 Sustainable 3 and youth care in order Value and care quality for and social Appreciation for good quality More quality, safety and transparency your money 4 assistance 4 and continuous improvement The right professional More quality in the right place 5 5 Opportunities for people People More freedom of choice and makes care Empowerment 6 entrepreneurs 6 Zero tolerance of Autonomy of decision on lifestyle choices 7 7 dependency abuse More freedom and accountability Appreciation for professionals for health care providers 8 8 More Trust Simplification and reduction of dynamics Reciprocity between administrative burden 9 in care 9 client and professional 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.
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