How do we keep our care sustainable?
In the past decade the Dutch healthcare has changed radically. The objective behind this was to make our healthcare system future-proof and sustainable. Affordable care is an important theme in this. Aging populations, increasing social expectations and an increasing number of medical options require new answers with limited healthcare budgets. The various stakeholders in health care need to reflect continuously on how to make health care more efficient so it will still meet the available budgets in the future.
Checkpoints of change
- Introduction of the Health Insurance Act (2006);
- Health insurance funds became health insurers;
- Healthcare providers were given more autonomy, but also have to account for themselves based on their performances;
- the Social Support Act (2007, 2015) and the Long-Term Care Act (2015);
- Municipalities as key players (in coordination) of social and youth care;
- The position of patients and clients has been strengthened by the introduction of the Quality, Complaints and Disputes Care Act (2016).
Core objectives of the chair of sustainable healthcare systemsCore objectives of the chair are research and education on affordable care. This concerns a wide area. After all, many changes in healthcare affect the subject of affordability. The affordability of care on the one hand is determined by the strength of the economy (amount of resources) and on the other hand by the willingness to contribute to collective care (solidarity). Extra health gains and quality of life cost increasingly more money. If more money is spend on healthcare, other collective expenses will be affected. Effective and appropriate care reduces this tension.
The chair focuses on three specific research lines: "expensive" care, network care and inappropriate care. The elaboration of these concepts often comes across a very unruly practice. As a result, there is a great need for concrete action perspectives, what we want to provide. In addition, we want to connect with social issues, in order to offer solutions and generate knowledge that will be relevant directly. Firm articulation of the issues is a precondition for this.
Within the Health Insurance Act, the top five percent of the "most expensive" patients and clients account for more than half of healthcare expenditure. In long-term care, expenditure is even more skew divided. We focus on strategies that can improve care for this group of people while making it more effective at the same time. For example, often there are coordination problems between different care providers. Previous research showed that multi-morbidity and to a lesser extent expensive facilities (IC, expensive drugs, transplants) are major cost drivers. In the Long-Term Care Act, the 24-hour stay is a major cause of these costs. It often concerns very sick patients and also the number of complications is high. This offers certain points of departur for improving this care, for example, complex case management and medication assessments in polypharmacy.
Networks are becoming increasingly important in healthcare. Underlying reasons are aging of the population, increase in multi-morbidity (of chronic conditions), live at home longer and an ever-decreasing hospital stay, the emergence of working in (care) teams and the (potential) decrease in transaction costs due to digital technologies and the Internet. The affordability of this network care is an issue in itself. Often all kinds of (project) organizations and special functions are created to set up and maintain the networks. Important themes for network care are, for example, the design of aftercare from the hospital and the coordination between municipalities, long-term care for the elderly and curative care.
Within this line of research, we focus on the de-implementation of (especially) inappropriate use of care. Nowadays there is a lot of insight into care with little or no added value in the treatment guidelines for doctors, as described in the do-not-do list. Examples are ear tubes in children, scans for low back pain and (unnecessary) protective measures against falling out of bed. A comparable list exists for nursing procedures. Nevertheless, inappropriate care is still applied persistently in healthcare practice. Insight alone is insufficient. Development of de-implementation strategies should contribute to accelerated de-implementation of inappropriate care.
The Celsus Academy was a program on sustainability of healthcare and initiated by the Ministry of Health, Welfare and Sport in the Netherlands, running from 2013-2018. The program was carried out by IQ healthcare, Radboudumc and focussed on knowledge development and the connection of policy, science and practice. It was the forerunner of the current Academy of sustainable healthcare systems (2019) and the reason for the installation of Professor Patrick Jeurissen on the Chair of sustainable healthcare systems (2016).