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Since 2007 health insurers have been developing a drug preference policy. The essence of this policy is that they negotiate directly with pharmaceutical companies on the price of generic drugs. They have been able to achieve considerable price discounts.
This policy combines ideas about patient oriented care (as opposed to supply dominated care) and disease management programmes for chronic diseases by developing a new funding system. Patient oriented funding integrates care from different providers in primary or secondary care. It can be provided by groups of care providers from primary or secondary care and can be purchased by health insurance organisations. Patient oriented funding will be introduced in January 2010 for four disease groups.
The new Health Insurance Act (Zorgverzekeringswet) has been in effect since January 1, 2006. The implementation of this act is just the first step in a reform process that is planned to last to at least 2012. This report gives a short overview of the reform and discusses some of its effects on consumer behaviour, insurer behaviour, its impact on choice and on healthcare expenditure and its redistributive effects.
The Dutch Ministry of Health is establishing a national infrastructure for data exchange between electronic patient records (EPR's). The core of this infrastructure is an index that connects all EPR's of a patient. In 2008 the first pilots come to an end and the first subsystems will be rolled out. It is a highly complex development with many stakeholders involved, which makes a successful outcome not yet evident.
Nurse practitioners (NPs) provide specialized nursing services, under supervision of a physician for medical tasks but highly independent for nursing tasks. They are educated at master level. Education for NPs started in 1997. Currently the number of students is 429 (2007) and the number of active NPs is estimated at 635 (1 January 2008). Three quarters of them work in a hospital. Stage of policy process: adaptations of the law to recognise nurse specialists and to allow restricted actions.
A key element of the new basic health insurance (2006) was the introduction of a no-claim arrangement (NCA). After two years of experience the arrangement has been abolished. It proved to be an ineffective and administratively highly complex instrument. Furthermore it was considered an unfair arrangement. Since 2008 it has been replaced with a mandatory deductible (MD) of 150 euro (103 euro for persons with chronic illnesses) for insured aged 18 years or older.
An important aspect of competition in health care concerns the organisation of hospital care. Competition is fostered by improving the possibilities for new providers to enter the market of hospital care. This implies a radical shift in healthcare policy, because until about 2000 it was the government's policy to discourage the entrance of new providers because there was 'plenty of capacity for specialist care'.
The introduction of managed competition requires transparent information for users. Parallel initiatives to provide this information were taken by health insurers, MoH, Health Care Inspectorate, and provider organizations. Information, available on a public website, is based on user experiences, measured with standardized questionnaires, and for hospitals on clinical (process) indicators. Public performance information is now available for health plans and several types of services.
Initiated by the Dutch MoH and based on reports of four captains of industry, effort has been undertaken to improve quality of hospital care. Five priority areas were defined; hospitals were given expertise and support. A robust evaluation scheme has been set up. First results show meaningful improvements. However, many projects don't achieve pre-stated objectives and there are no indications yet that results will be better than those of earlier, less expensive, so-called breakthrough projects.
The new Health Insurance Act (Zorgverzekeringswet) has been in effect since January 1, 2006. The implementation of this act is just the first step in a reform process that is planned to last to at least 2012. This report briefly discusses some effects of the new law as well as some further steps scheduled for the coming 4 years.