The policy and politics of the 2015 long-term care reform in the Netherlands.

As of 2015 a major reform in LTC is taking place in the Netherlands. An important objective of the reform is to reign in expenditure growth to safeguard the fiscal sustainability of LTC. Other objectives are to improve the quality of LTC by making it more client-tailored. The reform consists of four interrelated pillars: a normative reorientation, a shift from residential to non-residential care, decentralization of non-residential care and expenditure cuts. The article gives a brief overview of these pillars and their underlying assumptions. Furthermore, attention is paid to the political decision-making process and the politics of implementation and evaluation. Perceptions of the effects of the reform so far widely differ: positive views alternate with critical views. Though the reform is radical in various aspects, LTC care will remain a largely publicly funded provision. A statutory health insurance scheme will remain in place to cover residential care. The role of municipalities in publicly funded non-residential care is significantly upgraded. The final section contains a few policy lessons.

[Reform of long-term care in the Netherlands: solidarity maintained?]. / Hervorming van de langdurige zorg: blijft de solidariteit behouden?

The reform of long-term care (LTC) in the Netherlands is a much debated topic. The reform essentially comes down to a shift in healthcare claims and a cutback. As of 1 January 2015, the Long-Term Care Act (WLZ) shall replace the Exceptional Medical Expenses Act (AWBZ). In doing so, parts of the AWBZ will shift to the Health Care Insurance Act (ZVW) and the renewed Social Support Act (WMO 2015), which will be carried out by municipalities. This is a significant change: whereas the AWBZ provides a right to care, the WMO commands delivery of tailor-made support. Care that falls under the WMO is only awarded if the capacity of persons seeking care, among others their financial resources and social network, are insufficient. Higher contributions than in the AWBZ may also be requested. These developments influence the experienced level of solidarity.

The governance of quality management in dutch health care: new developments and strategic challenges.

This article gives a brief sketch of quality management in Dutch health care. Our focus is upon the governance of guideline development and quality measurement. Governance is conceptualized as the structure and process of steering of quality management. The governance structure of guideline development in the Netherlands can be conceptualized as a network without central coordination. Much depends upon the self-initiative of stakeholders. A similar picture can be found in quality measurement. Special attention is given to the development of care standards for chronic disease. Care standards have a broader scope than guidelines and take an explicit patient perspective. They not only contain evidence-based and up-to-date guidelines for the care pathway but also contain standards for self-management. Furthermore, they comprise a set of indicators for measuring the quality of care of the entire pathway covered by the standard. The final part of the article discusses the mission, tasks and strategic challenges of the newly established National Health Care Institute (Zorginstituut Nederland), which is scheduled to be operative in 2013.

Care delivery pathways for Chronic Obstructive Pulmonary Disease in England and the Netherlands: a comparative study.

INTRODUCTION: A remarkable difference in care delivery pathways for Chronic Obstructive Pulmonary Disease (COPD) is the presence of hospital-at-home for COPD exacerbations in England and its absence in the Netherlands. The objective of this paper is to explain this difference. METHODS: Descriptive COPD statistics and care delivery pathways on all care levels within the institutional context, followed by a comparison of care delivery pathways and an explanation of the difference with regard to hospital-at-home. RESULTS: The Netherlands and England show broad similarities in their care delivery pathways for COPD patients. A major difference is the presence of hospital-at-home for COPD exacerbations in England and its absence in the Netherlands. Three possible explanations for this difference are presented: differences in the urgency for alternatives (higher urgency for alternative treatment models in England), the differences in funding (funding in England facilitated the development of hospital-at-home) and the differences in the substitution of tasks to nurses (substitution to nurses has taken place to a larger extent in England). DISCUSSION AND CONCLUSION: The difference between the Netherlands and England regarding hospital-at-home for COPD exacerbations can be explained in three ways. Hospital-at-home has proved to be a safe alternative for hospital care for selected patients, and should be considered as a treatment option for COPD exacerbations in the Netherlands.

Utilization of family planning services by married Sudanese women of reproductive age.

To explore differences in utilization of family planning services and predisposing factors, we surveyed 601 women from urban and rural areas of Khartoum state. About half were using modern family planning techniques; there were no significant differences in utilization rates between urban and rural settings. Contraceptive pills were the most frequently used modern method (47.7%) followed by intrauterine devices (10.2%) and injections (7.5%). Breastfeeding was used by around 33% of both groups. The rhythm method and withdrawal were more often used by urban women (22.2% and 8.6% respectively) than rural women (16.1% and 3.6% respectively). Use of male methods (condom; sterilization) was extremely low. Socioeconomic status, knowledge and education level were the most important determinants of using modern methods.

Utilization of family planning services by married Sudanese women of reproductive age

To explore differences in utilization of family planning services and predisposing factors, we surveyed 601 women from urban and rural areas of Khartoum state. About half were using modern family planning techniques; there were no significant differences in utilization rates between urban and rural settings. Contraceptive pills were the most frequently used modern method [47.7%] followed by intrauterine devices [10.2%] and injections [7.5%]. Breastfeeding was used by around 33% of both groups. The rhythm method and withdrawal were more often used by urban women [22.2% and 8.6% respectively] than rural women [16.1% and 3.6% respectively]. Use of male methods [condom; sterilization] was extremely low. Socioeconomic status, knowledge and education level were the most important determinants of using modern methods

Opinions on changes in the Romanian health care system from people's point of view: a descriptive study.

After 10 years of changes, the Romanian people were asked to assess the consequences of the reforms that were carried out through the health care system in the last decennium. This article studies the opinion of changes among individuals and socio-economic-demographic groups living in Dolj region. Such surveys are rare in Romania. People show to have different opinions on quality of care, accessibility and on attitudes of politicians to health care comparing the present state of affaires with the past one. Overall the people judge the actual situation preferable to the past. The elderly, the chronically ill and the people who believe that people were happier 10 years ago have a more critical view on the changes especially in terms of accessibility. The higher educated people have a more positive opinion on the consequences of the reforms. The results may help to improve the communication between policy makers and the population. It is suggested that the involvement of the citizens in the health care reforms may realize a better implementation of Romanian health care reforms. This involvement is lacking.

Economic evaluation in stroke research. An introduction.

BACKGROUND AND PURPOSE: Before developing new medical facilities or adapting existing facilities in the field of stroke, it is desirable to assess not only the medical, but also the economic consequences of such facilities. Economic evaluation studies differ from other outcome studies in the way that costs are compared with effects. The purpose of this paper is to give an insight into economic evaluation studies in the field of stroke, so that these studies become easier for neurologists to understand and to apply. SUMMARY OF THE ARTICLE: Crucial aspects in economic evaluation research are addressed successively, such as the techniques used and how the results can be influenced by the perspective of the study. The article also considers the inclusion of costs and consequences in economic evaluation research. At the end of this article, special issues in economic evaluation studies are presented such as discounting, sensitivity analysis, incremental analyses and ratios. CONCLUSIONS: Although neurologists have no direct responsibility for allocating scarce resources in the field of stroke, they are confronted with the results of these decisions in their everyday work. Because of this, it might be useful to have clear understanding of economic evaluation studies and their caveats.

Impact of insurance coverage type on laboratory test ordering behaviour of general practitioners.

BACKGROUND: There exists much variation between GP's in the use of laboratory tests. Although the requesting pattern of GPs has been extensively described in the literature, little is still known of the factors which influence the GP's test ordering behaviour. AIM: This study aimed to determine whether the payment scheme according to which general practitioners are reimbursed influences the laboratory test ordering behaviour. METHOD: The laboratory test ordering behaviour of the general practitioners of Tilburg, a town with 180,000 citizens in the south of The Netherlands, was studied during a four month period, in relation to the type of insurance coverage of the patients. Two types of insurance were considered: voluntary and compulsory. The data were collected from the laboratory administration and coupled with information obtained from two, interview rounds. RESULTS: Two findings support the hypothesis that the type of insurance coverage of the patient, has an impact on the test ordering behaviour of the physician: The ratio between laboratory requests for sickness fund patients and patients with a private health insurance was found to depend on the fraction of persons with a private health insurance within the family practice. This was tested with multiple linear regression analysis. General practices were divided into two subgroups, those with many > 29%) and few (< 29%), voluntarily insured patients. Where a patient was privately insured it was found that relatively more tests were ordered. In case of general practices with many voluntarily insured patients this distinction disappears. The relative proportion of voluntarily insured patients was found to be an important variable in explaining the test ordering behaviour of general practice physicians in Tilburg.

Changing relations between hospitals and primary health care: new challenges for hospital management.

Hospitals in the Netherlands are now operating in a rapidly changing environment. Most changes directly result from government's policy to achieve effective cost containment in health care. Some of them basically affect the existence and functioning of hospitals. These changing environmental conditions inspire hospitals to undertake innovative activities to protect or even strengthen their position. This will be illustrated below by a case in which a small acute hospital attempted to establish a close relationship with primary health care in order to protect its position. Our focus will be upon this innovative initiative and upon some management problems that must then be resolved.

Hospital budgeting in Holland: aspects, trends and effects.

Global hospital budgeting was introduced in 1983 in Holland; it was expected to be a much more effective instrument to cost containment than classic retrospective output reimbursement. Several underlying assumptions of hospital budgeting are discussed: it will encourage hospitals to improve efficiency; it will have no negative impact upon the quality of health care; it restores hospital autonomy to some extent; hospital managers are capable to implement more efficiency. Attention is also paid to the design of external budgeting and its implications for the link between planning and budgeting as well as the relationship between hospitals and insurers. The second part deals with several effects of hospital budgeting. There are indications that hospital budgeting is effective from a cost containment perspective; it goes along with a decrease in hospital production; it also affects the organization and policy-making of hospitals as well as the public-private mix in health care. A general conclusion is that the effects of hospital budgeting far exceed the effects for cost containment.