The Dutch Journey: Why the UK model works abroad Dr. Prabath Nanayakkara, MD, PhD, FRCP Head, section acute medicine Department of Internal Medicine VU University medical center Amsterdam The Society for Acute Medicine, 7th International Conference, 3-4 October 2013 • Dutch health care system • Comparison between the systems • (system-related) Problems in acute care • Solutions from the UK model Euro Health Consumer Index 2012 at a glance: Winner: Netherlands Runner-up: Denmark Third place: Iceland 1. Patient rights and information 2. e-Health 3. Waiting time 5. Range and reach of services provided 4. Outcomes 6. Pharmaceuticals Curative care: (pre 2006) • Tradition of private initiative –Hospitals, nursery homes privately owned –Medical specialists and general practitioners mostly private entrepreneurs (partnerships) • Mixed public/private insurance –60% social insurance (below average income level) –30% private insurance (no government interference) • Growing government interference (from ± 1980 onwards) –Main objective: Cost containment –Detailed price regulation, budgeting System-related problems stressed the need for reform Unexpected Financial Effects Around Income Threshold Lack of Cost Consciousness Consumers Lack of Transparency Fragmented Insurance Market Providers Insurers  Lack of efficiency  Lack of innovation  Waiting lists Booz & Company Different Rules Lessons from the Dutch Health Care Reform AK.pptx Prepared for Achmea 7 2006 The Competition Model Provider Compete for Consumers on the Basis of Quality Consumers Providers Insurers Compete with Each Other on the Basis of Quality of Contracted Care, Price, and Coverage of Extra Insurance Insurers Providers Compete with Each Other on Quality and Price for Insurance Contracts – Freedom of contracting (insurer ↔ health care provider) – Freedom of price negotiations – Freedom of capital investments (capital costs in DRG’s) government safeguards Compulsory acceptance for basic insurance Compulsory health insurance and income related subsidy Legally defined coverage of basis insurance No premium differentiation between insured Health Care Authority (market development, price regulation) – Health Insurance Board (package of entitlements, risk equalization) – Diagnosis treatment combinations – – – – – 5% increase every year sinds 2006 3% uninsured 4 conglomerates 90% martket AD Ziekenhuis Top 100 - 2013 Health care costs 1983: 4.9 % GNP 2012: 10.7 % GNP 66 Billion Over the next 15 years, ageing will continue to drive volume, but yearly impact does not exceed 1% Forecasted Population Ageing and Growth Estimated Impact of Ageing on Yearly Volume Growth (%) (In Mn People) 20 0,8 15 65+ 0,6 0,8 0,8 0,6 0,5 10 21–64 0,3 5 0,1 0–20 0,0 0 201 0 201 5 15.3% 202 0 19.9% 202 5 203 0 24.2% 203 5 204 0 204 5 27.1% 200 201 202 202 203 203 204 204 205 8 5 0 5 0 5 0 5 0 205 0 26.3% Share 65+ in Total Population  Hence, a strong need to reduce any volume growth on top of ageing Sources: United Nations; Department of Economic and Social Affairs; Booz & Company analysis Booz & Company Lessons from the Dutch Health Care Reform AK.pptx Prepared for Achmea 16 Medische bezetting Lack of beds Admissions and transfer from ED Length of stay • Only 10% > 72 hours uur Length of stay before 25% aantal opnames 20% mean 15% 2009 2010 10% 2011 2009:7,7 d 2010:7,9 d 2011:7,2 d 5% 0% 0-<1 1-<2 2-<3 3-<4 4-<5 5-<6 6-<7 7-<8 8-<9 9-<10 >10 dagen 30 Length of stay after Mean 6,0 d • LOS from7 to 6 days • More admissions < 3 day 31 Discharge within 3 days 32 opnemend specialisme INW 425 GAS 251 TRA 229 NEU 217 HGE 208 LON 150 NEF 128 URO 87 ORT 71 VAT 69 HEM 63 NCH 41 GER 35 ONI 27 CAR 24 anders 64 20% 12% 11% 10% 10% 7% 6% 4% 3% 3% 3% 2% 2% 1% 1% 3% Reduction in the mortality with the introduction of AAU • Reduction in the length of stay • Reduction of 50 beds in the hospital • Increase in discharges within 48 hours • Reduction in the hospital mortality rate Team Work An observational cohort study on geriatric patient profile in an emergency department in the Netherlands E.J.M. Schrijver 1,2,3 Q. Toppinga , O.J. de Vries , M.H.H. Kramer , P.W.B. Nanayakkara * 1 2,3 2 1,2 AAU Management Rapid acces clinics GP`s Internist – generalist Acute medicine Lab / Rad Hospital units Research Teaching Acute medicine fellowship First (pre) central commitee meeting: 07/11/2006 Inaugaral central committe meeting: 9 maart 2009 Register acute medicine specialists: 125/1992 internists 1125 NEWS Travels: Exploring the Performance of NEWS in a Dutch ED Dr Nadia Alam, Amsterdam Conclusions • Concept of Acute Admission units • UK has inspired acute medicine2014 specialists in SAMsterDAM the Netherlands • NEWS will travel (fast)