Dutch Powerhouse

Question 0

Can you compare the approach that the consumer healthcare powerhouse used and the WHO approach and can you explain why the Netherlands performs so well on their example and might do so poorly on others, what do you think about the approach of the powerhouse.

Answer 0

The who ranked the Netherlands on the 17 place .
Different approaches can have different outcomes
Depends on the different aspects they take into account for example certain health outcomes : costs of health systems and waiting list.

This aspects have an impact on the ranking and the final measurement. Important is also the methodology and the type of data they used.

Question 1

Why are some studies on the Dutch Health care contradicting

Answer 1

Because of the differences of framework ( which aspects of performance are measured) and the methodology ( type of data and how this data is analysed.

always take the framework and methodology into account.

Question 2

What did the Dutch healthcare performance report do in their study

Answer 2

Combining existing research ford different branches to get an overall view of the performance of the Dutch HC.

More transparancy and more accountability ( verantwoordelijkheid)

Question 3

What was the main goal and the main domain of the powerhouse

Answer 3

Main goal : improve health of the Dutch

Main domains : quality ,acces and costs

Question 4

How was quality divided

Answer 4

Quality was divided in effectivness and safety and responsivness

This is because the role of the government is to safeguard quality ,acces and affordability ( costs).

Question 5

What type of analysis can you do to compare

Answer 5

analysis over time within 1 country or compare with other countries
compare with the policy norms ( for example the time an ambulamce needs to be there).

Different levels of measurement : system ( national) and organizational ( hospital).

Acces and geography : how fast can a patient be in the hospital ( traveltime)
Timeliness : how quick beingh helped when you arrived in the hospital

Question 6

How do we weight all this different components to see if a health care system is good.

Answer 6

Using the who approach,so you look at the ranking that comes out of the measurement.

Question 7

Is a comparison between countries easy to make

Answer 7

difficult because they use different definitions

Question 8

What can policy makers do with the report

Answer 8

it helps them to get an overview
it sets priority were things can be improved
we can learn from other countries
it identifies knowledge gaps

Question 9

what is important when you present a report

Answer 9

you have to try to get a lot of attention because in the policy cycle it is not only about scientific evidence but also less rational arguments play a role.

information in the media gets more attention.
the impact of beliefs is bigger then the impact of evidence

Question 10

how is the framework of the DHCPR divided

Answer 10

it is divided in 4 aspects : prevention, cure, end of life care and long time care

Question 11

what are the conclusions of the DHCPR report

Answer 11

easy acces, healthcare for everyone
the costs of care are seldom a problem and everyone is close to the GP but there are LONG waiting lists and poor telephone acces to GP.

Question 12

do we get value for money in the netherlands accordind dhcp

Answer 12

in nl we pay more but also got more volume of care the last years.the rising costs are a big problem.
In international cost benefit comparison ,Nl performs about average.
On meso level some signs of inefficiency ,for example substantial variation in GP taruffs and hospital stay.
the Netherlands has the same problems as many EU countries : rising costs,ageing,rising chronic ill etc…

Question 13

what is the definition of health care systems

Answer 13

Healthcare is defined as activities aimed at alleviating, reducing, compensating and/or preventing deficiencies in the health status of autonomy of individuals (Van der Meer and Schouten, 1997). It is centrally concerned with the provision of care to individuals by professionals with a medical education, but also includes supportive activities conducted by assistants and management

Question 14

can health outcomes be Affected by non-medical determinants

Answer 14

–environment, public hygiene, nutrition

–case-mix (patients characteristics such as age, comorbidities)

Question 15

what are the solutions here

Answer 15

-Take into account these methodological concerns

• Add additional information about structure and process
• e.g. treatment given within x-hours after accident

-And: how do patients experience health care process (responsiveness)

Question 16

how can measurements differ from each other

Answer 16

–Based on: scientific evidence, expert opinion, HSPA studies OECD, WHO and other countries

–Internal and external review process (experts and policy makers)

–Types of analyses: over time, international, policy norms

–Different levels of measurement: system (national) and organisational (hospitals)

Question 17

do you have to take something into account when comparing different frameworks.

Answer 17

yes very important to look at

statistical uncertainty (shown in last graph)
–case-mix ( difference in age ,comorbidity)
–registration quality

Question 18

what is the conclusion of the Dutch powerhouse report

Answer 18

●Easy access, varying quality and rising costs
●Challenges:
–Control of rising healthcare costs
–Growing shortage of manpower
–Care for the elderly is under pressure
–Transperancy is lacking
●The Netherlands has a well-functioning system in various respects, but faces many challenges

Question 19

what are the problems that policy makers are facing

Answer 19

\:
–Rising costs (and a financial crisis)
–Disparities
–Ageing of the population
–Lack of human resources
–Specific health problems
–Value for money?
–Priority setting

Question 20

What is the difference between the who and dhcp

Answer 20

Difference with WHO checking on equivalent en distribution because they check on country level.

The Dutch Healthcare performance because they check on healthcare provider level. And equity among only can be solved on country level.

WHO measure 5 therms and DHCP measure by 126 indicators.

Question 21

What did the dhcp do

Answer 21

Assessing the quality,accesability abd cost of the dutch hc system,compared performance with standards,with previous years and with other countries.

Question 22

How is hc divided in this framework

Answer 22

Prevention,cure,long term care and end of life care

The indicator is well accepted internationally. The oecd adopted this framework

Question 23

Is there a wide variation between healthcare providers in the netherlands according the dutch health care performance rapport

Answer 23

Yes ,there is a reserved approach towards medical interventions ( vb antibiotica)
But also a wide variation in treatments. This confirms the importance of best practie approach.

Question 24

What can they do about this variation according dhcp

Answer 24

More information about quality of care and patients outcome because now it is a lack.