Transcript Primary health care in the Netherlands: current situation

Primary health care in the
Netherlands: current situation and
trends
Prof. Peter P. Groenewegen
NIVEL – Netherlands Institute for
Health Services Research
Contents of my presentation
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Definitions
Numbers
Regulation, funding and payment
Problems
Trends
Definitions
Primary care is ….
• generalist care, consisting of general medical,
paramedical and pharmaceutical care, nursing and
supportive care, and non-specialised mental and
social healthcare, together with preventive and
health educational activities linked to these forms
of care.
(Health Council of the Netherlands, European
Primary Care)
Characteristics of strong primary
care
• A generalist approach
• The point of first contact with health care
• Context-oriented
• Continuity
• Comprehensiveness
• Co-ordination
Starfield
Boerma, Fleming
Effects of strong primary care
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Better health outcomes
Good quality care
Lower costs
Better opportunities for cost containment
Better opportunities for monitoring health,
health care utilisation, quality, and
preparedness
Providers of primary care
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Key providers: general practitioners
Pharmacists
Physical therapists
Home care
Primary care obstetrics (midwives)
Primary mental health care
Social work
Numbers
Primary care manpower 2003
General practitioners
Pharmacists
Physical therapists
Home care
Midwives
PC Psychologists
Social workers
Number
(absolute)
8,110
2,650
13,250
55,000 (FTE)
1,500
1,285
3,370
Inhabitants per
FTE provider
2,400
6,100
1,320
290
2,280 (WFA)
16,000
7,600
Increasing share of female GPs
100%
80%
60%
male
40%
female
20%
0%
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Increase in numbers and in full
time equivalents
8000
7000
6000
5000
fte
4000
individuals
3000
2000
1000
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Decrease in share of singlehanded practices
Year
Singlehanded
partnership group
1993
72%
21%
7%
1998
68%
24%
8%
2003
62%
26%
12%
Regulation, funding and payment
Regulation of general practice
• Three years of specialty training
• Re-accreditation every five years,
conditional on an average of 40 hours CME
• Gate keeping
• Contracts between GPs and public
insurance carriers
• Professional guidelines
Funding and payment
Current situation
• Publicly insured
patients (60%):
capitation
• Privately insured
(40%): fee per
consultation
From next year
• Fee per consultation
• capitation
Problems
Primary care as a whole
• Undersupply and oversupply
• Teams, networks and individuals
• Different sources of funding
Shortage of manpower in general
practice
Proposed solutions:
• More prevention
• Cost-sharing to curb demand
• Retaining older GPs
• Delegation of tasks within GP practice
• Shifting tasks to other providers
• Better organisation (e.g. out-off-hours care)
Trends
From supply-side policy to
demand side policy
• Increased patient choice
• Better informed patients
• Is gate keeping a sustainable system?
From self-governance to
management
Changing role of third parties:
• Insurance companies
• Performance indicators
Increasing scale of organisation
• Differentiation of professional work and
practice management
From calling to occupation
• Health care as product that can be sold in a
market
• From GPs as personal doctors to institutions
that provide care
• Outside demands on practitioners (the
balance between private life and
professional life)
Changing occupational structure
in health care
Specialisation in nursing
• Practice nurses
• Specialised clinics between hospital and
primary care
In-between professions
• Nurse practitioners
• Physician assistants
Conclusions
• How strong is primary care in the
Netherlands?
• Will primary care survive the health
insurance reforms?
• Will GPs regain their professional pride and
vanguard role?