Nederlands Huisartsen Genootschap

Dutch College of General Practitioners

Arno Timmermans, president

Dutch Health Care System

Dual System• General law on exceptional health care costs (27 %)

long term treatments (nursing homes, long term semi permanent hospitalisation) disability costs

• Health Insurance (41 %)• All essential health care, mandatory, universal coverage, private

health insurers• Additional optional health insurance packages (4%)• Taxes (14 %)• Out of pocket (9%)• Others (4%)

Universal basic coverage

• Premium not related to health status or age• Children under 18 free• Compensation for low incomes

Funding: 50 % employers

45 % insured person

5 % government

Premium: approx. $130 a month (variation approx. 5%)

Primary Care in the Netherlands

• Most GP’s self employed or working for another GP

• Patient list• Gate keeper system• Standard GP list 2350• Consultation rate 6/ year (consultations,

telephone consultations, prescriptions)• Combined: capitation fee and fee for service

Primary Care in the Netherlands

GP Practice:•GPs (most group practices, health centers, fewer single

handed)

•Practice assistants

•Practice nurse (chronic care)

Other primary care workers:•Physiotherapists, dieticians, midwives, psychologists,

district nurses , pharmacists

Best survey findings: costs as a barrier

Best Survey findings: visit to the emergency care

Best Survey findings: Diabetes HbA1c

Poor performance: coordination of care

Poor performance: coordination of care

Strategy :• Improving collaboration GP´s/ medical

specialists-hospital• Strengthening the role of GP’s/GP

practices as coordinator of care