1. A Dutch national perspective on chronic diseases and healthcare quality management Invitational conference on chronic lung diseases Utrecht September 23rd 2011
Arnold Moerkamp
Dpt. Director General for Healthcare
Ministry of Health, Welfare and Sports 1

2. Issues: 1. Challenges 2. Strategies 3. Integrated care 4
Issues: 1. Challenges 2. Strategies 3. Integrated care 4. Establishing a national healtcare quality board

3. Challenges Increasing healthcare demand
The good news is: we live longer
Increasing healthcare demand
Shortage of manpower and funds in healthcare
Ageing and technology
Decreasing labour market
Voettekst

4. How bad is that...? Shortage of manpower and funds
Threat on financial sustainability
Shortage of manpower and funds
Threat on healthcare solidarity
Threat on healthcare quality
Voettekst

5. Four possible strategies
Professional treatment of only half of the patients by prioritising
Double productivity by financial incentives and new IT based technologies
Halve healthcare demand by prevention and integrated healthcare for chronic diseased
All possible combinations
Voettekst

6. How do we do that...? Prioritise patients Increase productivity
Reducing inter-doctor variation
Prioritise patients
Reducing insured entitlements
Pay for performance
Increase productivity
Increasing burden of risk insurance co’s.
Reduce healthcare demand
Integrated care
National healthcare quality board
Voettekst

7. Integrated care: better care, lower costs
good practices, to name a few...
- Integrated COPD care
(Mid Holland region)
- Multidisciplinary program heart failure
(Noordwijk)
- Disease management program DiabeteszorgBeter (Northern region)
- Transmural cooperation GP’s and Med.Spec (Southern region)
more good practices on
Voettekst

8. Preconditions for integrated care
rearrangement of the healthcare landscape
back to basics at the local level
rearrangement of the professional landscape
MS  GP’s NP’s  self management
cooperation at the local level
end of mono disciplinary practices
e-health support
supporting self management
Voettekst

9. Integrated care so far disease management arrangements
e-health needs boost
cooperation is growing
2007: 40% of GP practises multi disciplinary
2011: 50%
Developing:
Heart failure
Depression
Obesity
Dementia
CVA
Diabetes
COPD VR
Voettekst

10. Formal cooperation primary healthcare
Voettekst

11. A national institute for healthcare quality
The national institute will facilitate, assess, register and publish professional standards
A professional standard includes patient focussed integrated description from start to end of (multidisciplinary) treatment, professional guidelines, quality and safety standards, quality, safety and efficiency indicators, outcome indicators and benchmarks
The national institute will publish information to facilitate patients to make their choices, insurance companies to contract healthcare providers, the national healthcare inspectorate to supervise and enforce
Voettekst

12. The national institute: beyond permissiveness
Professionals and patients in the lead, the national institute will facilitate
The national institute will set a meta standard and assess professional standards
The national institute will take over if a proposed professional standard doesn’t meet the meta standard
The national institute will facilitate implementation of a professional standard
Voettekst

13. Summary
Sustainability of future healthcare urges to reorganize the healthcare landscape
Patient focussed integrated care enables better care at lower costs
Focus on quality performance and transparency of outcomes will challenge professionals to perform better
The new national institute for healthcare quality will focus on efficient integrated care and outcome performance and thus will contribute to sustainable future healthcare
Voettekst

14. Thank you
Voettekst