Brief Introduction to the Health System of the Netherlands

Presentation by Bibiche Wymenga,Department of International Affairs

9 February 2011

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

(Source: VTV Public Health Forecast 2010, National Institute for Public Health & the Environment (RIVM))

10

9

8

7

6

5

4

3

2

1

DementiaPneumoniaBreast Cancer

AccidentsSelf-inflicted InjuryDiabetes

ArthrosisDementiaColon Cancer

Respiratory COPDHeart FailurePneumonia

Lung CancerBreast CancerRespiratory COPD

DiabetesRespiratory COPDHeart Failure

Anxiety DisorderColon CancerDementia

StrokeStrokeStroke

DepressionCoronary Heart DiseaseLung Cancer

Lung CancerLung CancerCoronary Heart Disease

Burden (DALY’s)Lost Years of LifeMortality

2. The Ministry of Health, Welfare & Sport

Policy department:• International Affairs Dept.

Advisory and support departments:• Financial & Economic Affairs Dept.• Operational Management Dept.• Legislation & Legal Affairs Dept.• Personnel & Organisation Dept.• Information & Communication Dept.• Management Support Dept.

A. Kleinmeulman

Deputy SGSecretary General

G. van Maanen

DG General Health Care

L. van Halder

• Dept. Health Care• Dept. Medicines & Medical Technology• Dept. Market & Consumer

DG Long-term Care

M. Boereboom

• Long-Term Care Dept. • Health Insurance Dept. • Macroeconomic Issues & Employment Conditions Dept.

DG Youth & Social Care

M. van Gastel

• Social Support Department• WW II Victims Remembrance Unit• Youth Care Department• Youth & Families Programme

MinisterMs. Edith Schippers

Portfolio• Financial Policy & Administration• Health Care & Public Health• Infectious Disease Control• Pharmaceuticals & Devices• Markets, Quality, Consumers• Sport• Innovation & Technology• Education, Labour Market, Ethics• Agencies & Inspections

State SecretaryMs. Marlies Veldhuijzen van Zanten - Hyllner

Portfolio• Long-Term Care• Social Support• Youth Care, Elderly Care• Disability Care• Biotechnology & Research

DG Public Health

• Dept. Public Health• Dept. Nutrition, Protection and Prevention• Dept. Sports

P. Huijts

Ministry of Health, Welfare & Sport

Health Care Inspectorate (IGZ)

RIVM - National Institute for Public Health and the Environment (including Centre for Infectious Disease Control)

Netherlands Vaccine Institute (NVI)

Food and Consumer Product Safety Authority (VWA)

Health Council (GR)

Social Cultural Planning Office (SCP)

Central Information Unit on Health Care Professions (CIBG)

Health Care Authority (NZA)

Health Care Insurance Board (CVZ)

Medicines Evaluation Board

• Netherlands Organization for Health Research and Development (ZonMW)

Stichting Fonds PGO (funding for national patient & disability organizations and senior citizens’associations)

AGENCIES WITHIN THE MINISTRY(3500 employees)

INDEPENDENT GOVERNMENTAL BODIES(600 employees)

3. From former to current health system

Characteristics of the Dutch Health Care system

•Tradition of private initiativeHospitals, nursery homes are privately ownedMedical specialists and general practitioners are mostly private entrepreneurs

•Former health insurance system60% 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 containmentDetailed price regulation, budgeting National & regional planning & licensing

Pros & cons of the former system

•Pros Cost containment on macro (national) levelPolicy implementation through intervening in the systemQuality (of health care delivery)

•ConsMacro efficiency, micro inefficiencyLack of spirit of enterprise & innovative climateRationing → waiting lists

•Growing pressure on the systemDemographics (ageing & labor market)Technology developmentsLaw suits because of waiting lists !

Public InsuranceCivil servants

Private insurance (1/3)

Sicknessfunds (2/3)

Health Insurance

Act

• Compulsory insurance (consumers)• Open enrolment (insurer)• Legally defined coverage (insurer)• No premium differentiation (insurer)• Submission to risk adjustment (insurer)• Income related contribution (consumer)

• Compulsory deductible (consumers)• Free to set nominal premium (insurer) • Free to offer different policies (insurer)• Free to offer suppl. deductible (insurer) • Free to engage group contracts (insurer)

The insurance reform 2006

Managed competition

Equity

Efficiency

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

Sustainablecare

and socialassistance

Carefulnessclose to home

People makes care

Zero tolerance ofdependency abuse

Empowerment

7

6

Appreciation for professionals8

Reciprocity between client and professional9

Appreciation for good quality and continuous improvement

Organisation of long term care and youth care in order

4

3

More quality5

Tailored care with affection

Municipalities facilitate easy access to youth care and social assistance

2

1

Value and quality for

your money

Health care and sports

nearby

Opportunities for people

andentrepreneurs

Autonomy of decision on lifestyle choices

More freedom of choice

More freedom and accountability for health care providers

Simplification and reduction of administrative burden

More quality, safety and transparency

Pay for performance

The right professional in the right place

Sports in your neighbourhood

Basic care close to home

7

6

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9

4

5

2

1

3

Trust in care

More dynamics

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.