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Ernst_Healthe System


									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
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

                                       Ms. Edith Schippers
                                                                                                      State Secretary
                                       • 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
         (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)
                                                     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

•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
     Cost containment on macro (national) level
     Policy implementation through intervening in the system
     Quality (of health care delivery)

    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)
                       •   Legally defined coverage (insurer)
     funds (2/3)
                       •   No premium differentiation (insurer)
                       •   Submission to risk adjustment (insurer)
  Health               •   Income related contribution (consumer)

  insurance (1/3)
                                      Managed competition

     Act               •   Compulsory deductible (consumers)
                       •   Free to set nominal premium (insurer)
    Public Insurance
     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
                                                 and sports
                                                                   close to home
     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
                                                  for people         People
         More freedom of choice                       and           makes care                   Empowerment
                                            6   entrepreneurs
                                                                                                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
     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

• National Institute of Public Health & the Environment

• Netherlands Organisation for Health Research & Development
Thank you for your attention.

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