Health(care) in the Netherlands - TFHC · Value-Based Health Care eHealth Elderly Care....

Health(care)

in the Netherlands

Health~Holland Visitors Programme 2018

Workshop

09:00 Welcome by ModeratorPeter Post, Director, Task Force Health Care

09:05 Welcome & OpeningErik Gerritsen, Secretary-General, Ministry of Health, Welfare & Sport

09:15 The Dutch Health(care) System: Accessibility,

Quality & AffordabilityProf. Patrick Jeurissen, Chief Research Scientist,

Ministry of Health, Welfare & Sport

10:15 Coffee Break

10:45 Parallel Sessions

Value-Based Health Care | eHealth | Elderly Care

12:00 Networking Lunch

Innovation Climate & PPPs for Innovation in Health (15 min)

By Prof. dr. Nico van Meeteren, Executive Director, Health~Holland

13:00 End

Agenda

Warm welcome!热烈欢迎

Bienvenido

Velkommen

Herzliches Willkommen Selamat datang

Tervetuloa

Välkommen

ласкаво просимо Bem-vindo

Bienvenue

गर्मजोशी से स्वागत

Karibu sana ಸ್ವಾ ಗತ






10:15 Coffee Break






13:00 End

Agenda

Going Dutch? If “context”

is not transferrable what

remains?

Prof. dr. Patrick Jeurissen

Top the leagues?

http://www.google.nl/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwit4v-9qYjTAhUFWBoKHd1PBnwQjRwIBw&url=http://www.commonwealthfund.org/publications/press-releases/2010/jun/us-ranks-last-among-seven-countries&psig=AFQjCNEV0Nh9AtXvEcvYkQ_9vSH9g9Qc-A&ust=1491310175639800

The Netherlands: average crude health(Healthy) live expectancy Female smokers

NL

SE

IT

0 50 100 150 200

SwedenMalta

CyprusItaly

PortugalIreland

LuxembourgSpain

United KingdomNetherlands

FinlandFrance

GermanyAustria

DenmarkEU average

GreeceBelgium

Czech RepublicLatvia

SloveniaEstonia

BulgariaSlovakia

LithuaniaPolandCroatia

RomaniaHungary

2000

2015

Preventable mortality

Preventable hospitalizations

Age standardized rates per 100.000 population

How expensive is Dutch ‘care’?

6

7

8

9

10

11

12

1983 1988 1993 1998 2003 2008 2013

Netherlands European Average

A-typical growth pattern: pro-cyclical (% GDP)Health expenses OECD member states

(%GDP)

Understanding the context of Dutch healthcare.

Institutional constraints that withstood ‘reforms’

• Maximizing risk-solidarity (OUP expenses; benefit basket; risk-

adjustment; egalitarian health outcomes; community rating; open

enrolment)

• Gatekeeper is the family physician (increases risk-solidarity)

• Self-employed hospital doctors (exception university clinics)

• Large general acute-care nonprofit hospitals; care normally ‘around-

the-corner’

• High penetration tertiary care, very high research outputs

• Average hospital care sector; large long-term care sector

• Stewardship: consensus-based governance model

• Low volumes, high prices?

High-use of longterm care

3036

42

72

1983 1990 1997 2010

Per capita square meters in nursing homes

0

1

2

3

4

5

6

7

8

9

10% GDP

LTC expenditure projection 2013 - 2060

Bridging equity and efficiency? Going Dutch? Regulated competition at work?

Corrective governance mechanisms

Open enrolment &

universal coverage

Multiple payers

(Selective) purchasing

Hospitals

Provider innovation

(Higher) productivity

StewardshipMOH: systemMOF: global budget

Agencies

IndependentCentral bankCompetition authorityCentral economic bureau

Arms-lengthHealth market authorityHealthcare Institute

InspectoratesPatient safetyFraud and abuse

Semi-private governanceSocial-economic councilCovenants: building coalitionsCredit enhancementProfessional standardsInterest groups

1. Community rating 2. Deductible3. Subsidies lower incomes4. 50% payroll tax

1. Solvency setting2. Risk adjustment3. Group contracts4. Indemnity / Managed

care

1. VBID2. Selective purchasing /

P4P3. Free rates (70%)4. Quality indicators

1. Independent non-state facilities2. Free investments (>90%)3. State-of-the-art quality4. (Self-employed) physicians5. Free-provider-choice

Assessment: ten years ‘market reforms’

Corrective governance mechanisms

Open enrolment &

universal coverage

Multiple payers

(Selective) purchasing

Hospitals

Provider innovation

(Higher) productivity

1. Uninsured: 194.000 (2009) to 20.000 (2016)2. Switching: 3.6% (2006) to 7.3% (2015)3. Avg. flat premium: €1226 (2012) t0 €1203 (2016)

1. Solvency: 17% (2006) to 27% (2014)2. Overhead: 4.5% (2006) to 3.2% (2014)3. Groups: 55% (2006) to 69% (2012)4. Some mergers

1. Few changes market share (3%)2. Volume caps and budgets (>90%)3. Few price conversions

1. Solvency: 9.1% (2004) to 21.5% (2015) 2. Overhead: 19.79% (2011)3. Price increases 2006 to 2009: 9.5% (A) and 4.8% (B)4. # Hospitals: 99 (2005), 84 (2014)

1. ASC: 37 (2006) to 176 (2011)2. FP Hospitals: 2 (2009)3. Outpatient clinics: 61 (2009) to

112 (2014)

1. Hospital productivity: 2.5%2. Avg. length-of-stay: 7.9 (2002)

to 4.7 (2010)3. No waiting lists

Diffusive policy paradigms in LTC

New services

Core residential

UniversalTarget groups

Client demands

Fixed provisions

How to assess clients?

Longterm care (2015): inpatient, outpatient, community

Cost control 2012 – 2018: so far so good, is it safe?Table: Forecasted and real average flat premium (€)

Over(under) spending BKZ (mrd. €) Increasing solvency (% total assets)

′06 ′07 ′08 ′09 ′10 ′11 ′12 ′13 ′14 ′15 ′16

Forecast 851 879 1057 1074 1085 1211 1222 1273 1226 1211 1243

Realization 771 848 1050 1059 1095 1199 1226 1213 1098 1158 1203

Difference 78 31 7 15 -10 12 -4 60 125 53 40

The why of successful cost control

Less growth in health expenses (2012 – 2018)

1. increase deductible, abolishing certain financial compensations for chronically ill

2. risk-bearing insurance companies

3. national covenants (to limit growth in expenses)

4. limiting budgets for long-term care

5. devolving services to municipalities

Ending risk equalization

Also more financial risk by enrolees

′11 ′12 ′13 ′14 ′15

none 94% 93,1% 90,3% 89% 88%

€100 1,4% 1,4% 1,4% 1,4% 1,4%

€200 0,9% 0,9% 1,1% 1,3% 1,3%

€300 0,8% 0,9% 0,7% 8% 0,7%

€400 0,1% 0,1% 0,2% 0,2% 0,2%

€500 2,7% 3,6% 6,2% 7,3% 8,3%

Voluntary deductible

Declining numbers of patients/clients on a low baseline

2008 2009 2010 2011 2012 2013

outpatient 405 400 403 408 384 393

inpatient/daycare 226 239 251 265 268 246

remaining hospital 521 544 543 578 618 667

V&V zzp > 4 142 156 158 163 186 170

V&V uren 143 148 151 180 184 178

VG verblijf 170 181 181 189 195 194

VG dagbehandeling 589 561 529 529 523 502

# patients and clients (1980 = 100)Per capita expenses pharmaceuticals

Active purchasing? Few changes in provider market shares (MVI)

0,0%

2,0%

4,0%

6,0%

8,0%

10,0%

12,0%

14,0%

16,0%

2006/7 2007/8 2008/9 2009/10 2010/11 2011/12 2012/13 2013/14

hospital care

elderly care

disability care

municipal care

personal budgets

-1

-0,8

-0,6

-0,4

-0,2

0

0,2

0,4

0,6

0,8

1

-0,6% -0,4% -0,2% 0,0% 0,2% 0,4% 0,6%

chan

ge in

co

ntr

acte

d c

are

Change in market share

Active purchasing in-vitro fertilization?

0%5%

10%15%20%25%30%35%40%45%50%

Success rates (5-year average)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1996 1998 2000 2002 2004 2006 2008 2010 2012 2014

AMC

VU

Marketshare Amsterdam

Some conclusions

• Regulated competition and fiscal sustainability may align (2012 -2018)

• Responsiveness to changes: reforms alter mental models

• Lower volumes in an aging society, a need for careful watching

• Efficiency: steering on best-practices

• Aligning trends in epidemiology/technology with budgetary policy

• Do not disturb intrinsic motivation by professionals

• Do not put all your cards on active purchasing

What makes a healthcare system sustainable?

❑ Good performance on 1) access, 2) quality, 3) efficiency, affordability

❑ No ‘golden’ bullets from a health system perspective (OECD, 2010) & very difficult to change context by policy reforms

❑ Powers for endogenous improvements more important:1) To ‘innovate’ along the lines of value/efficiency2) To ‘correct’ for value destroying behaviours3) To build ‘resilience’: solvency, capital investments, workforce

Thank you for your attention






10:15 Coffee Break






13:00 End

Agenda


Value-Based Health Care eHealth Elderly Care

Outcome-based healthcareDimitri Schakelaar, Program manager Outcome based healthcare, Ministry of Health, Welfare & Sport

Learning CoalitionsPaul Boon, Project lead for ‘Learning coalitions’, National Health Care Institute

eHealth Policy

By Ron Roozendaal, Director of Health

Information Policy & Chief Information Officer,


Elderly Care Policy

Martin Holling, Ministry of Health, Welfare &

Sport

Evidence-based solutions for Ageing Society

Prof. Dr. Robbert Huijsman, Erasmus School of

Health Policy & Management


Innovation Climate & PPPs for Innovation in Health (15 min)By Prof. dr. Nico van Meeteren, Executive Director, Health~Holland

13:00 Transfer to Field Visits

@T

FH

ea

lthca

re

Thank you!

Lets have some coffee

Health(care) in the Netherlands - TFHC · Value-Based Health Care eHealth Elderly Care....

Documents

Transcript of Health(care) in the Netherlands - TFHC · Value-Based Health Care eHealth Elderly Care....