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Drs. SPM (Steven) de Waal<br />The future of (professional) entrepreneurship in primary care<br />

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Public SPACE Research in Primary Care<br />Public SPACE, Center on Strategies for Public And Civic Entrepreneurship is a private, independent Think Tank, aimed at the development of ‘Winning Strategies for the Common Good’, from the perspective of civil society.<br />This project is in cooperation with the Dutch National Association of Small and Medium sized Employers and ABN AMRO Bank<br />Main focus on general practitioners, dentists, pharmacists and physiotherapists<br /><ul><li>Is there a future for (small) professional entrepreneurship in primary care? Under what conditions and what will be the public effect on primary care?

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How to cope with big institutions like health insurers and hospitals?

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What must be the effect on government policy?</li></li></ul><li>Demands from a public perspective<br />General:<br />- Accessibility (geographical, acute care, outside working hours, information) <br />- Affordability<br />- Quality<br /><ul><li> Cost control (direct and indirect)</li></ul>Specific:<br /><ul><li> Prevention

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Substitution

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Appropriate care

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Complex care/cure

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ICT in information (EPD) and care (domotics)</li></ul>INCREASING PRESSURE; CURRENT ORGANIZATION NOT UP TO IT<br />

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Demands from a professional perspective<br /><ul><li> Autonomy in practice

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Limited competition

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Enough market demand

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Long term income (challenged: claw back; (very) low tariffs)

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Choice to work on the payroll

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Potential and room to develop / specialize and grow (economically, professionally)

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Network of collaboration with colleagues, as backup</li></ul>NOT TOO MANY WORRIES; PRIMARY CARE IS STILL AN ATTRACTIVE ENVIRONMENT FOR PROFESSIONALS<br />

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What is ‘a professional’?<br />Perspectives:<br />GUILD<br />REGULATION <br />(law or government enforced)<br />MARKET<br />Variables:<br />* Uniqueness of competence and talent;<br />* Extremeness of training;<br />* How much is compentence linked to persons?;<br />* Does reputation work?;<br />* Does client recognize AND value uniqueness?;<br />* How much competition and choice?<br />

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Sphere of influence around the professional<br />Laws and regulation<br />The healthcare insurer<br />Public criteria<br />and pressure<br />The professional<br />Patients with an attitude<br />Technology and Innovation<br />The culture of the professional peergroup<br />Entrepreneurship<br />Professional codes and demands<br />

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What kind of Entrepreneurship?<br />SMALL SHOP (survival&autonomy)<br />INCOME MAXIMALIZATION<br />Short TermLong Term<br />Cost Reduction Patient Loyalty<br />Increase of Turnover Specialization&<br /> Innovation<br /> Geographical Growth<br /> (e.g. franchising and acquisition)<br />SOCIAL ENTREPRENEURSHIP<br />Actual PatientorientedPotential Patientoriented<br />Prevention (creating public value)<br />Appropriate care<br />Broader Services<br />Seamless care <br />

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Gap analysis Primary Care<br /><ul><li> More integrated

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Multidisciplinary

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Case management

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Accessibility

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Electronic patient files

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More compatible ICT solutions

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Innovation</li></li></ul><li>Possible and Actual Scenario’s<br />Within primary care:<br />Outside primary care:<br />Combinations are possible<br />Multi-<br />disciplinary<br />Other Health care providers<br />Mono-<br />disciplinary<br />The Professional<br />Strategic Corporate partner <br />Solo<br />Strategic partner healthcare insurer<br />Backoffice<br />

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Roles of Professionals and others<br />

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Preliminary CONCLUSIONS (for debate)<br />* (Professional) entrepreneurship delivers a better answer to future challenges and call for differences than a national blueprint of (geographical) integrated care;<br /><ul><li> Classical professional hierarchy is not concurrent with the culture of entrepreneurship in professions in primary care;

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Too many incentives, e.g. pay-for-performance, promote short term income maximalization;

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Current entrepreneurship is mainly cost-driven and monodisciplinary, while challenges are in innovation and multidisciplinary cooperation (care/cure and organization).</li></li></ul><li>Preliminary Conclusions (2)<br /><ul><li> There is an opening needed for outside, non-professional entrepreneurs, mainly because of culture, scale and capital;

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In that case there are special regulations necessary for professional autonomy and public access;

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Best partners for primary care are health insurers and retail;

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Hospitals and pharmaceutical industry have to be excluded from the entrepreneurial role in primary care.</li></li></ul><li>About The Public SPACE FoundationThePublic SPACE Foundation is the international knowledge and learning centre for Strategies for Public And Civil Entrepreneurs. As an independent, nonpartisan ThinkTank we focus on complex and strategic interactions between government, civil organizations and industry for public purposes. On a non-profit base we develop and provide realistic, tailored innovative strategic solutions to all sectors contributing to the public domain. The results of our work are communicated to public and private decision-makers and to the general public by books, articles, debates, lectures and an interactive website. Public SPACE was founded in 2000 by Steven de Waal and has, in its short existence, built a reputation in developing and communicating leading edge strategies for and between established organizations for public purposes.<br />Our MissionOur mission is to research and design innovative and sustainable strategies for the production of public services and collective goods. We want to contribute to ’Winning strategies for the common good’ characterized by an open non-ideological inquiry, an active international outlook for best practices and an interdisciplinary approach.<br />The ThinkTank<br />Our ThinkTank consists of prominent executives, academics, opinion leaders and decision makers operating in strategic frontiers of public/private corporations. They have backgrounds in all domains of public interest and in a broad range of organizations. <br />