Dept Social Medicine

Primary Health Care in The NetherlandsPrimary Health Care in The Netherlands

- relic of the 20th or saviour of the 21th century -

Niek Klazinga

Dept Social Medicine

Dept Social Medicine

Why The Netherlands might be Why The Netherlands might be of interest for the USAof interest for the USA

• private insurers• private practice• mandatory health insurance for all citizens• strong primary health care system

Dept Social Medicine

Dept Social Medicine

Health insurance in The NetherlandsHealth insurance in The Netherlands

• regulated private insurance market since 2006• mandatory basic insurance• mandatory acceptance• voluntary supplementary insurance• nominal competitive premiums• contribution via employer• tax-based health care subsidy for persons with

a low income• risk-equalization fund

Dept Social Medicine

Primary Care in The NetherlandsPrimary Care in The Netherlands

• 8000 GP’s (13.000 specialists)• average practice 2400 persons• broad professional profile• registered patients• gate-keeper function• solo, duo, group-practices• pharmacists, midwives, allied-health professionals• complementary public health system at level

municipalities

Dept Social Medicine

Quality assurance of GP care

• GP training, CME, visitation, re-registration

• National guideline programme NHG

• Peer-review activities

• Practice evaluation

• Emerging systems of indicators and P4P

Dept Social Medicine

Dept Social Medicine

Dept Social Medicine

Dept Social Medicine

Dept Social Medicine

Relic?Relic?

• eroding gate keeper function (occupational medicine,youth medicine, nursing home physician)

• outsourcing out-of-hours care• less psycho-social care• delayed organizational upscaling• labour market shortages• ownership shifting to other providers and insurers

Dept Social Medicine

Saviour?Saviour?

• embedding prevention function in primary health care

• embedding long term care in primary health care

Dept Social Medicine

• well developed information infrastructure• high level of professionalization GP’s• well developed quality policies• initiatives with task substitution and new professions• experimentation with organizational models• linkages with public health, long-term care and

hospital care• preferences patients and insurers• potential for benchmarking

Dept Social Medicine