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Health Care Systems in NL, CZ & SK Assoc. Prof. JP van Dijk MD PhD Dept Community & Occupational Medicine University Medical Centre Groningen University.

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Presentation on theme: "Health Care Systems in NL, CZ & SK Assoc. Prof. JP van Dijk MD PhD Dept Community & Occupational Medicine University Medical Centre Groningen University."— Presentation transcript:

1 Health Care Systems in NL, CZ & SK Assoc. Prof. JP van Dijk MD PhD Dept Community & Occupational Medicine University Medical Centre Groningen University of Groningen The Netherlands

2 Health Care Systems in NL, CZ & SK Assoc. Prof. Jitse P van Dijk MD PhD Senior Lecturer ‘Social Determinants of Health’ Olomouc University Society & Health Institute Palacky University Olomouc Czech Republic

3 Health Care Systems in NL, CZ & SK Assoc. Prof. Jitse P. van Dijk MD PhD Scientific Director Graduate School Kosice Institute for Society and Health Medical Faculty Safarik University, Košice Slovak Republic

4 Outline 1Similarities between the HC Systems 2Dissimilarities between the Systems 3Health care expenditures of the Systems 4Organisation of the System 5Some numbers, productivity &c 6Financing Elements of the System 7Access to the System

5 Organisational types - different Take home message: national: within the borders of the internationally identical typology financial-economical compromises and history determine its appearance – and make them at first glance rather different

6 Health Care Systems NL, CZ & SK Bismarck systems: (Bismarck was the German Chancellor about 1870) The Netherlands, Czech Republic, Slovakia Health Insurance Companies [subtypes: public (CZ, SK) / private (NL)(CZ, SK)] have a major role in - financing health care provides - reimbursing costs patients made - collecting premiums [- planning HC] Decision on height premiums: - central government or HIC

7 HC Expenditures, %GDP: NL, CZ&SK NL: 11.77% GDP for HC CZ: 7.42% GDP for HC SK: 7.60% GDP for HC

8 Organization of the system - CZ CZ Hospitals Nursing homes - Home care GP’s, organised in neighbourhood centres or per employer

9 Organization of the system - SK SK Hospitals - GP’s, organised in neighbourhood centres or per employer

10 Organization of the system - NL NL Hospitals Nursing homes Homes for the elderly Private houses with care from the home for the elderly Home care GP’s, organised in centres or solo

11 Main figures – CZ, SK, NL Hospital beds NursHHEldPrivHHomeC GP’s CZ6.47‰?--?1 GP / 1444 inh SK5.80‰----1 GP / 2386 inh NL4.66‰????1 GP / 1397 inh

12 Consultations CZ, SK&NL Consultations GP & medical specialist NL6.20 CZ11.09 SK11.04

13 Hospitals – CZ, SK & NL CZ State (Central / district / municipality)(50%) Non-profit(50%) SK State (Central / district / municipality)(44%) Non-profit(27%) Private (29%) NL State: University Hospitals(± 8%) Non-profit (foundation or association)(± 92%)

14 Hospital productivity CZ, SK&NL ‰ hospital beds hospital discharges [inhabitants, mln] length of stay (days) NL4.71,850,715 [16] 5.8 CZ6.52,023,822 [10] 6.6 SK5.8892,072 [5] 6.2

15 Hospitals – CZ, SK & NL Life expectancy at birth Healthy life expectancy at birth MFMF NL76.381.061.761.4 CZ72.178.662.863.3 SK69.877.7[52.1][52.3]

16 Financing the System’s Elements CZ Individual HC providers Fee for service Specialists: fee for service GP’s:Small amount ffs Capitation fee GP’s: largest amount GP income: cf

17 Financing the System’s Elements SK Individual HC providers Fee for service Specialists: fee for service GP’s:Small amount, extra services Capitation fee GP’s: Basic income; fee dependent on age patient

18 Financing the System’s Elements NL Individual HC providers Fee for service Before 2005: specialists; GP’s for private patients Capitation fee Before 2005: GP’s only cf for sick fund pts After 2005: GP’s for all pts capitation fee + small ffs DRG After 2005: specialists financed from the hospital’s DRG

19 Financing the System’s Elements Institutional HC providers: NL, CZ & SK Expenditures / Bed days, afterwards (NL hospitals before 1982; CZ*; SK until 2014) Budget (NL hospitals till 2005) Diagnosis Related Group NL DBC >2005; CZ*; SK >2014 ‘budget per diagnosis + treatment + aftercare’

20 Financing the System’s Elements Institutional HC providers: CZ Expenditures / Bed days, afterwards (CZ: district h) Budget (CZ: district h; faculty h) Diagnosis Related Group (CZ: faculty h) ‘budget per diagnosis + treatment + aftercare’

21 Financing the System’s Elements Diagnosis Related Group – expected effects Competition on price Exclusion by HIC Specialization Merger / strategic collaboration Smallest hospitals will disappear (outpatient clinic)

22 Access to the System Lay referral system * enter after own decision the system everywhere as far as I see & hear: SK Gatekeeper system * enter the system only after referral GP  NL & CZ

23 Main trait of the Systems CZ & SK * partly general (for everyone) but also partly specific, for a factory, etc NL * general (for everyone) exception: army

24 Organisational types - simple Take home message: international: rather simple; just a very few choices national: within the borders of the typology financial- economical compromises determine its appearance

25 Thank you for your attention!

26 QUESTIONS??

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