June 2009
C.J. (Kees) in ’t Veld, MD, GP
Netherlands College of General Practitioners
See presentation (pp): General Practice in the Netherlands
General Practice in the Netherlands (16 million inhabitants) holds a strong position in the health care system. The 8500 GPs in the Netherlands, working in 4500 practices, have listed patients and are goalkeepers for hospital based, specialised care.
Trends
- more and more female collaegues are joining GP-practices
- the number of single-handed practices is steeply decreasing. The most recent figure (2008): 20%
From 2006 onwards a new insurance system with a key role for Healt Care Insurers is effective.
A more market-oriented health care approach is meant to improve quality and that for a better price.
Key-words
- health insurance is mandatory for everyone
- insurance companies ‘purchase’ care
- transparancy on performance indicators will enable patients to make their choice
June 2009
Prophecies…
Not all prophecies do come true. That saying also goes for the effects of the reform.
The system changed less than some expected, for better or for worse. Purchasing care proves to be difficult, indicators are not that easy to denominate.
The Netherlands College of GPs (NHG) tries to improve the quality of primary care by formulating guidelines, preparing methods and materials for continuing professional development (‘life-long learning’) and by endorsing practice visits (NHG-Practice Accreditation).
Cost containment: some medication is no longer insured, e.g. benzodiazepins, oral contraceptives, paracetamol, while in other cases just the generic drugs are refunded, e.g. statins: simvastatine, pravastatine, PPI’s: omeprazol.
There are initiatives to refund chronic care (Diabetes, Asthma/COPD, Depressive disorder, Heartfailure) as a Diagnosis-Treatment combination, so for every patient with diabetes the health care provider gets in a fixed amount, regardless the provider of care. Fragmentation of care could be the result of this approach. Both College and Assoiation strongly endorse a generalistic approach from General Practice.
P4P might be a new way of remunerating professionals depending of the level of their care provided.
The first preliminary results of an experiments show an improvement of the quality of care, but there are also reports from other countries where ticking the boxes proves to be he way of performing.
Patient safety: a new way of looking towards Quality. Safety is an aspect of Quality! Government efforts are put into making a Safety Management System obligatory for each Healt Care Institution, for each practice delivering Primary Care.
‘Safe’ reporting of incidents and accidents is promoted, although there is a tendency towards listing bad performers on the internet and increase the severity of punishment, which is not a very safe environment to experiment!
The Netherlands College and Association of GPs co-operated in the preparation of a set of indicators for Primary Care to be tested (feasability) in the Autumn of 2009.
The Practice Assessment Programme (NPA) is slowly gaining ground amongst the professionals. More than 2000 of the 8500 GPs are participating in the scheme, over a 1000 GPs are accredited.
The GP teaching practices will be enrolled. That gives thrilling expectations for the improvement of General Practice!
The improvement plans of practices enrolled in the NPA cover a wide range of subjects.
Looking at practice management the top three consists of introducing Protocols in daily practice, for instance on improving hygiene in the practice, Improving the accessability of the practice by telephone and the institution of structured practice meetings. But the top three only makes up for 34 % of the plans.
In the medical domain the top three is for nearly 80% directed towards improving the care for the chronically ill.
For further information please contact: c.intveld@nhg.org
