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Dutch Journey toHealth Care Reform 2006 –  A reflective Overview        Rob Halkes
Reconstruction ofHealth Care Reformin the NL                     1. 1980 – 2000                            Cost Containmen...
Overview HCD – the system in general                                                           1. Cost containment        ...
The Dutch HC Journey characterised                                   1. Costs of Care Rising – what to do?        1. 1980 ...
Overview HCD – the Pharma Journey                                   1.   Costs of Care Rising – what to do?        1. 1980...
To some generalization?      1.   1980 – 2000                               1. Awareness of costs and   Cost Containment &...
What if you are amidst thesedevelopments and you do want to      create a better market condition to health innovation,   ...
Forecast of development is trickyTrends give direction but it is not sure what will dominate.   Scenario studies give only...
Systems’ forces that change Health Care• Protocol development (evidence based medicine)  • Creation & Standardization of p...
To develop competitive advantages we need to         think ahead of developments  When You Don’t Choose Your        Market...
What are examples to enact         new forces to change?• Standardization: co creation of integrated care – stakeholder  i...
ReferencesApart from general knowledge and public sources(like the Dutch public periodicals: Financieel Dagblad, de Volksk...
Drs. A.R.J. Halkes MHArob.halkes@healthbusinessconsult.com               P.O. Box 292             5050 AG Goirle          ...
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Dutch journey to health care reform 2006

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The Dutch Health Care Reform 2006, a reflection
Having witnessed the movement of the Dutch Health Care Reform (see Wikipedia), it is inspiring to review it to evaluate what processes and forces have initiated the development and formed its course. In discussing possibilities for moving desired developments, we were reflecting on what processes or factors might be used to work along to stimulate innovation and change.

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Dutch journey to health care reform 2006

  1. 1. Dutch Journey toHealth Care Reform 2006 – A reflective Overview Rob Halkes
  2. 2. Reconstruction ofHealth Care Reformin the NL 1. 1980 – 2000 Cost Containment 2. 2000 – 2006 Awareness - System redesign? Towards market Liberalisation 3.2006 – 2010 Health Care as (regulated) Market 4. 2010 – 2020? Integrating Care – Chronic Focus Redefining and Rationalisation Patient empowerment Ehealth
  3. 3. Overview HCD – the system in general 1. Cost containment 1. 1980 – 2000 Costs of Care Rising – what to do? Pricing – Budgeting – Supply (e.g. number of specialists)? Cost Containment 2. Price/budget ceilings don’t work so what now System Redesign? 2. 2000 – 2006 Looking for structural solutions: Awareness - System redesign? Redesign Financial arrangementsTowards market Liberalisation New HC structures – Integrating Processes of Care - multidisciplinary collaboration – Innovations? 3. Liberalisation as starting point (choice of system) HC Insurance companies as market directors 3.2006 – 2010 • New financial models: from budget per capita to performance based –Health Care as (regulated) Market DRG - B-segment – Negotiations • Fees and salaries under pressure • Strategic Focus at HC organisations (Hospitals – Clinic) 4. Building/ Programming for Care 4. 2010 – 2020? • Differentiated attention:Integrating Care – Chronic Focus Chronic - integrated Primary care focus - Acute care to be rationalised – Redefining and Rationalisation Clinical focus – super specialisation Patient empowerment • Disease management – Ehealth – Integrated pricing Ehealth • Restructuring Primary and Secondary care
  4. 4. The Dutch HC Journey characterised 1. Costs of Care Rising – what to do? 1. 1980 – 2000 • Trends leading to higher demands for care • Parties and specifically payers, become aware of costs Cost Containment & • Budget control Supply Control • Pricing measures – Electronic Prescription Systems(ErxS) – substituting specialty drugs for generic 2. Price/budget ceilings don’t work so what now • Discussion of entrepreneurship in Care 2.2000 – 2006 Towards market Liberalisation • Insurance companies no more obliged to contract care. Budget negotiations Pharmaceutical Care GP&Ph • Trans mural projects of collaboration (in – outpatients) • Rationalisation of Rx & Pharmaceutical care • Local protocols GP – Pharmacists (FTO) 3. Liberalisation 3.2006 – 2010 • HC insurers marketing: Consumer prefer low prices – patient focused services Health Care market - • Pharmacy preference pricing Insurers as market directors • Cherie picking by initiators early adopters (ZBC – specific clinics) • Looking for transparent DRG system – based on disease protocols • Liberalisation of prices – negotiations 4. Programming for Care 4. 2010 – 2020?Integrating Care – Chronic Focus • Differentiated attention: Redefining and Rationalisation Chronic – integrated Primary care focus - Acute care to be rationalised – Patient empowerment Clinical focus – super specialisation of professionals and centres Ehealth • Disease management – Ehealth – Integrated pricing • Patient empowerment – Technology – Ehealth
  5. 5. Overview HCD – the Pharma Journey 1. Costs of Care Rising – what to do? 1. 1980 – 2000 2. Pricing measures – ERxS – substituting Specialty drugs for generic 3. OPA (Omni Party Agreement – self-regulation did not work) Cost Containment & 4. Towards promotion control Supply Control 5. Reference pricing (ERxS) max. prices - ‘claw back’ because of margins 2. Price/budget ceilings don’t work so what now • Covenant: Price reduction generics 40% (2004, 2005) 2.2000 – 2006 • HCI: preference policy Omeprazol Towards market Liberalisation • Rationalisation of Rx & Pharmaceutical care Pharmaceutical Care GP&Ph • Local (FTO) protocols GP – Pharmacy • Account focus - Managers 3. Liberalisation • Dutch Health Care Authority (NZA): market analysis towards long term 3.2006 – 2010 policy of free pricing? Health Care market - • Effects of price pressure - Standards of Care - price inclusion? Insurers as market directors • Diminishing Access (to market, to Prescribers • Contraction of care by Health (primary) Care Groups • Chronic, integrated care focus 4. 2010 – 2020? 4. Programming for Care – Disease managementIntegrating Care – Chronic Focus • Differentiated attention: Redefining and Rationalisation Chronic – integrated Primary care focus - Acute care to be rationalised – Patient empowerment Clinical focus – super specialisation Ehealth • Disease management – Ehealth – Integrated pricing • Care coming Home
  6. 6. To some generalization? 1. 1980 – 2000 1. Awareness of costs and Cost Containment & Cost Containment Supply Control 2.2000 – 2006 2. Preparing for Towards market restructuring Liberalisation Pharmaceutical Care (partial) redesign GP&Ph 3.2006 – 2010 3. Structural Redesign and Health Care market - RedefinitionInsurers as market directors 4. 2010 – 2020?Integrating Care – Chronic Focus 4. Building phase and Redefining and work out? Rationalisation Patient empowerment Ehealth
  7. 7. What if you are amidst thesedevelopments and you do want to create a better market condition to health innovation, to your health business, to health care costs ?
  8. 8. Forecast of development is trickyTrends give direction but it is not sure what will dominate. Scenario studies give only a grand view of possible configurations of development. But, being within a journey,we only need to know in what direction the next step of development will move… .. to have an informed choice for actively taking part in that development, to create a better market condition.
  9. 9. Systems’ forces that change Health Care• Protocol development (evidence based medicine) • Creation & Standardization of programs of care (integrated Care) • Political reorganisation of Health Care System• Cooperation between disciplines or parties involved • Technology • Financial aspects (budget cuts) • Patient empowerment Reshaping our thinking..
  10. 10. To develop competitive advantages we need to think ahead of developments When You Don’t Choose Your Market Strategy – You can only be satisfied with the “Left Overs” of others
  11. 11. What are examples to enact new forces to change?• Standardization: co creation of integrated care – stakeholder involvement - expert committees - support to implementation – support of experimenting for better care processes• Protocol development: consensus meetings• Cooperation between disciplines or between parties involved: local co-creative process development• Technology, both in medical science and communication (internet, social media, mobile applications)• Financial arrangements: exploring possibilities for contributions by parties with interest (e.g. employers, cooperation, collectives - stimulus programs from payers)• Patient empowerment – internet platforms and associations
  12. 12. ReferencesApart from general knowledge and public sources(like the Dutch public periodicals: Financieel Dagblad, de Volkskrant etc.;and specific Dutch Heath Care journals: Zorgmagazine, Zorgvisie, ZNetwerk, PharmaceutischWeekblad, Medisch Contact, Zorgmarkt, etc.),we like to refer to the following sources par example:- Putters, K. Geboeid Ondernemen, een studie naar het management in de Nederlandse Ziekenhuiszorg.van Gorcum 2002.- Niet van later Zorg, Wie het weet mag het zeggen, Ministerie VWS, Den Haag 2007.- Diagnose 2025, Over de toekomst van de Nederlandse gezondheidszorg, Philip Idenburg, Michel van Schaik. Scriptum 2010.- Naslag #1, Historisch kader Geneesmiddelen standaard. Persoonlijk paper, KNMP. Den Haag augustus 2007.- See also Hans Maarse, Markthervorming in de zorg, Maastricht 2011
  13. 13. Drs. A.R.J. Halkes MHArob.halkes@healthbusinessconsult.com P.O. Box 292 5050 AG Goirle The Netherlands M +31 6 31 66 2595 T http://www.twitter.com/rohalF http://www.facebook.com/rob.halkes L http://nl.linkedin.com/in/arjhalkes W www.healthbusinessconsult.com

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