1. Common Wealth Fund Webinar February 5, 2013
Primary Care in The Netherlands: General Practitioners in the Lead Jako Burgers, MD, PhD Dutch College of General Practitioners
Common Wealth Fund Webinar
February 5, 2013

2. Characteristics of the Dutch health care system2
Complete coverage for all residents (< 1% uninsured)
All patients are registered in one general practice
General practitioner is gatekeeper to hospital and specialist care
Balance between external, governmental systems and internal, professionally led systems for quality improvement 2

3. Primary Care in Netherlands: Basic Characteristics
10,000 general practitioners (GPs), 7,800 own practice
100% have practice assistant, 80% practice nurse
GP is family physician covering whole population
GPs offer out-of-hours service covering whole country
60% of income is capitation fee, 30% fee-for-service, 10% special services (1-2% P4P)
No co-payment for GP visit
Satisfaction with GP is high (8 on scale from 0 to 10) 3

4. Health Information Technology
Eight different software programs for general practice
All support electronic drug prescription, incl. prompts
Most support ordering of laboratory testing, imaging, and referral to hospital care, incl. info on waiting time
Generating panel information and feedback on performance is slowly improving
consultation and refill request is increasing 4

5. Access and perceived barriers
Increasing problems with paying bills or out-of-pocket costs: from 5% in 2007 to 42% in 2012
Significant reduction of coverage in basic health care package and increasing premiums in 2012
Waiting times have reduced due to increasing competition between hospitals and public reporting
Access to GP and after-hours care is well perceived 5

6. Care Coordination
Practice nurses support chronic care (diabetes, COPD, cardiovascular risk management), and increasingly elderly care
Involving specialized practice nurse in mental health care is ongoing
Communication between medical specialist and GP:
brief message on same day on hospital admission and discharge
full letter after 2 to 4 weeks (on paper or electronically)
phone consultation on demand
use of local protocols strongly varies per region 6

7. Financial incentives
Additional care contracts on diabetes, COPD, and cardiovascular risk management (some insurers)
Flu vaccination ($ 12 per patient), cervix screening ($ 14 per patient)
Practice nurse (0.4 fte per 2,350 patients)
$ 20 for home visits versus $ 10 for doctor visits and $ 5 for phone calls 7

8. Quality Assurance
Continuing Medical Education is mandatory for re- license (every 5 years)
Participation in peer review groups is mandatory
40% of GPs applied for practice accreditation, including:
Assessment of organizational/structural capabilities
Clinical performance feedback
Patient satisfaction survey
National research institute and some insurers provide feedback on test ordering and hospital admission 8

9. Can other countries learn from Dutch general practice?
Key factors for success:
National government supports primary healthcare
Strong, well-accepted national professional organization
Payment system supports regular doctor and integrated patient care
Longstanding evidence-based guideline program
Collaboration and local peer support are essential 9