Primary health care in the Netherlands: current situation and trends

1. Primary health care in the Netherlands: current situation and trends Prof. Peter P. Groenewegen NIVEL – Netherlands Institute for Health Services Research

2. Contents of my presentation • Definitions • Numbers • Regulation, funding and payment • Problems • Trends

3. Definitions

4. 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)

5. 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

6. Effects of strong primary care • Better health outcomes • Good quality care • Lower costs • Better opportunities for cost containment • Better opportunities for monitoring health, health care utilisation, quality, and preparedness

7. Providers of primary care • Key providers: general practitioners • Pharmacists • Physical therapists • Home care • Primary care obstetrics (midwives) • Primary mental health care • Social work

8. Numbers

9. Primary care manpower 2003

10. Increasing share of female GPs

11. Increase in numbers and in full time equivalents

12. Decrease in share of single-handed practices

13. Regulation, funding and payment

14. 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

15. Current situation Publicly insured patients (60%): capitation Privately insured (40%): fee per consultation From next year Fee per consultation capitation Funding and payment

16. Problems

17. Primary care as a whole • Undersupply and oversupply • Teams, networks and individuals • Different sources of funding

18. 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)

19. Trends

20. From supply-side policy to demand side policy • Increased patient choice • Better informed patients • Is gate keeping a sustainable system?

21. 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

22. 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)

23. 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

24. 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?