Dutch Health Care Performance Report 2008

This is the second national report on the performance of the Dutch health care system. Its focus is on quality, access and costs in 2006/7. The Dutch Health Care Performance Report presents a broad picture based on 110 indicators. Where possible, comparisons in time and between countries are presented. Dutch health care is accessible, cost increases are average, but further improvements in quality can be made The Netherlands has an accessible health care system. Since 2004, health care expenditure has risen annually by 5%. This rate of growth is comparable to that of neighbouring countries. Although for many aspects of care the quality is high, the Netherlands does not excel at an international level. The general public and care users are positive about the care provided, but there are differences between the various types of care. One concern is the availability of nursing and care personnel. Coordination and cooperation in health care and patient safety score relatively low. The efﬁ ciency of health care in the Netherlands is not optimal. Quality is not a driving force in the health care market. RIVM: 260602004 ISBN: 978-90-6960-195-3 Westert GP, Berg MJ van den, Koolman X, Verkleij H (editors) Dutch Health Care RIVM National Institute for Public Health and the Environment Performance Report 2008 Public Health and Health Services Division P.O. Box 1 3720 BA Bilthoven The Netherlands T +31 30 274 9111 www.healthcareperformance.nl DUTCH HEALTH CARE PERFORMANCE REPORT 2008 DUTCH HEALTH CARE PERFORMANCE REPORT 2008 Westert GP, Berg MJ van den, Koolman X, Verkleij H (editors) Centre for Prevention and Health Services Research Public Health and Health Services Division National Institute for Public Health and the Environment P.O. Box 1, 3720 BA Bilthoven, The Netherlands T +31 30 274 9111 www.healthcareperformance.nl A publication by the National Institute for Public Health and the Environment P.O. Box 1 3720 BA Bilthoven The Netherlands www.rivm.nl All rights reserved © 2006 National Institute for Public Health and the Environment, Bilthoven, The Netherlands. The report was originally published in Dutch under the title: Zorgbalans 2008. De prestaties van de Nederlandse gezondheidszorg The greatest care has been devoted to the accuracy of this publication. Nevertheless, the editors, authors and the publisher accept no liability for incorrectness or incom- pleteness of the information contained herein. They would welcome any suggestions concerning improvements to the information contained herein. All rights reserved. No part of this publication may be reproduced, stored in an auto- mated database or made public in any form or by any means whatsoever, whether electronic, mechanical, using photocopies, recordings or any other means, without the prior written permission of the National Institute for Public Health and the Environ- ment. In as much as the production of copies of this publication is permitted on the basis of Article 16b, 1912 Copyright Act in conjunction with the Decree of 20 June 1974, Bul- letin of Acts, Order and Decrees 351, as amended by the Decree of 23 August 1985, Bulletin of Acts, Orders and Decrees 471, and Article 17, 1912 Copyright Act, the appro- priate statutory fees should be paid to the Stichting Reprorecht (Publishing Rights Organization), PO Box 882, 1180 AW Amstelveen, The Netherlands. Those whishing to incorporate parts of this publication in anthologies, readers and other compilations (Article 16, 1912 Copyright Act) should contact RIVM. RIVM: 260602004 ISBN: 978-90-6960-195-3 FOREWORD FOREWORD This is the second Dutch Health Care Performance Report. It provides a concise overview of the performance outcomes of Dutch health care and has been written as a monitoring report. The facts and figures provide a cross-section of the performance outcomes from 2006 and 2007, the first two years after the new health care system came into force. It therefore provides a first systematic review of the quality, accessibility and costs of care in the Netherlands following the health care system reforms on 1 January 2006. The National Institute of Public Health and the Environment (RIVM) has compiled the Dutch Health Care Performance Report (DHCPR) on behalf of the Ministry of Health, Welfare and Sport, based on a framework of performance indicators developed in col- laboration with researchers from the OECD and several Dutch universities and knowl- edge centres. As a result of this, the contents of the second DHCPR has a stronger evidence base. Both the state secretary and I believe it is vital that we have access to good information concerning the performance outcomes of health care suppliers in the Netherlands. It facilitates transparency within the health care sector. Health care organizations are working hard to increase our understanding of health care suppliers’ performance and the opinion of health care users about their performance. We therefore expect the DHCPR to become more complete and accurate over the coming years. Key questions for me in the second DHCPR are the relative performance of the Neth- erlands compared to other countries and whether the introduction of the new health care system has been a favourable development. Although it is still far too early to draw firm conclusions, I am satisfied with the initial findings. The Netherlands contin- ues to perform well. We have an accessible health care system and the care offered is mostly within good reach. On average the quality of care has increased slightly and although costs have risen, these rises are in line with those in neighbouring countries. The average Dutch person has confidence in the Dutch healthcare system and in the affordability of the necessary care. However, the report also shows that there is clear room for improvement. There are countries whose health care expenditure is lower than that of the Netherlands and yet in terms of health outcomes and the safety of care, for example, are comparable to us. Equally there are also countries with similar health expenditures that perform better than the Netherlands. Interestingly, although there are many initiatives and projects in the Netherlands regarding innovation in care processes, their outcomes are all too often not evaluated properly. Consequently we still know far too little about the dissemination of these innovations throughout our country. Over the next few years, we will need to devote particular attention to further progress in the health care system reforms, long-term care, the coordination between health care providers, and safety in the provision of care. In this context, the effects of a tight 5 FOREWORD labour market should not be underestimated. The DHCPR provides a wealth of data and insights into all of these areas. With the overview provided by the DHCPR on quality, accessibility and cost of care in our country, we have a good empirical foundation on which the Ministry of Health, Welfare and Sport can build its priorities for the next few years. The DHCPR provides a sound basis for the policy agenda that focuses on a high-quality and solidarity-based health care system for a healthy Dutch population, which the State Secretary and I strive for. Ab Klink, Minister of Health, Welfare and Sport 6 CONTENTS CONTENTS FOREWORD 5 EXECUTIVE SUMMARY 9 1 BACKGROUND AND APPROACH 19 2 QUALITY OF HEALTH CARE 25 2.1 Quality of care 25 2.2 The effectiveness of prevention 27 2.3 The effectiveness of curative care 36 2.4 The effectiveness of long-term care 48 2.5 The effectiveness of mental health care and addiction care 60 2.6 Patient safety 66 2.7 Innovation in health care 77 3 ACCESS TO HEALTH CARE 87 3.1 Accessibility of care 87 3.2 Financial access to care 88 3.3 Geographical access to care 94 3.4 Timeliness of acute care 100 3.5 Waiting for regular care 105 3.6 Access according to needs 112 3.7 Personnel availability 119 3.8 Freedom of choice 128 4 COSTS OF HEALTH CARE 135 4.1 Affordability of care 135 4.2 Trends in health expenditure 138 4.3 The financial position of health care organizations and health insurers 145 4.4 Labour productivity in health care 151 5 CONNECTING THEMES 155 5.1 Introduction 155 5.2 Health care ratings of the general public and care users 156 5.3 The efficiency of the Dutch health care system 172 5.4 Market forces and the effects of the health system reform 185 6 TOWARDS THE DUTCH HEALTH CARE PERFORMANCE REPORT 2010 203 6.1 Introduction 203 6.2 Ambitions, improvements and limitations 203 6.3 The usefulness of the Dutch Health Care Performance Report 208 6.4 The Dutch Health Care Performance Report continued 209 7 CONTENTS REFERENCES 211 APPENDIX 1 225 APPENDIX 2 229 APPENDIX 3 235 8 EXECUTIVE SUMMARY EXECUTIVE SUMMARY Using more than 100 indicators, the Dutch Health Care Performance Report (DHCPR) describes the performance outcomes of Dutch health care in 2006 (and part of 2007). The DHCPR provides a broad picture of the accessibility, cost and quality of Dutch health care. Where possible this is done using time series data and international comparisons. In this second DHCPR, special attention is paid to three themes: the efficiency of health care, the opinion of the public about health care and the effects of the health care system reforms. The first DHCPR was published in 2006 and described the situa- tion in 2004 (Westert and Verkleij, 2006). How well does the Dutch health care system score internationally and what trends are present? Accessible, cost increases are average, but further improvements in quality can be made The Netherlands has an accessible health care system. Since 2004, health care expenditure has risen annually by 5%.

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