Department of Health, Welfare and Sport Transition of the Dutch health care system focused on hospital care May 26th 2005 Marc Soeters Maaike Prins Diagnosis

Department of Health, Welfare and Sport

Transition of the Dutch health care system focused on hospital care

May 26th 2005

Marc Soeters

Maaike Prins

Diagnosis Treatment Combinations


Agenda

• Presentation on the transition of the Dutch health care system with focus on the hospital market (20 minutes)

• Questions


presentation

• Problems with old system• Outline new health care system• Focus on hospital care and introduction of

DBCs


Old system of health care

• Government regulated system:– prices/tariffs– Budgets– Capacity (hospitals)– Insurers obligated to contract all suppliers

of health care


Problems

• large increases of budget in past years• But still shortage (waiting lists) and

complaints about quality


New health care system in Cure• Central role Insurers in contracting (and

organizing) health care • With efficient contracting and organizing

health care insurers can lower costs (and lower insurance premiums)

• Competition on insurance market forces them to keep premiums low with efficient contracting


Conditions insurer market

– Competition on the market for health care insurers

– Level playing field on insurer market (new law on general health insurance)

– Risk-equalisation (ex ante, not on actual expenses)

– Selective contracting of health care supply


Requirements on supply of hospital care

• Enough competition on supply side of hospital care

• Transparent products (DBCs)• No negotiations on prices on acute

hospital care (and some other minor parts of the hospital market)


Introduction of DBCs in 2005• Definition of hospital products in terms of

DBCs (diagnosis treatment combination)• Contracting on prices and quantity for 10%

of the DBCs • 90% government sets prices within budget

system


DBC development in the Netherlands

• Started slowly in mid 90’s

• Initiated by providers and insurers

• Adopted by government in 2000

• Implemented by January 2005

• Market oriented approach for 10% of hospital products


What is a DBC?

• DBC: Diagnosis Treatment Combination

• Uniform defined health process description

• Description of the total health path

• Cost homogeneous and medical coherent


Summary of unique aspects DBCs• Episode management / medical process

description

• DBCs are applicable for all hospital activities (including outpatient and daycare)

• DBCs include the remuneration of medical specialists

• Registration during the health care process


Scope DRG

GP Outpatient visit(s)

Clinical episodes

Homecare

GP

Rehab /Aftercare

Daycare


GP Outpatient visit(s)

Clinical episodes

Homecare

GP

Rehab /Aftercare

Daycare

Scope DBC


DBC versus DRG

DBC DRG

Patient classification based on clinical process summary by episode of care including the outpatient visits, clinical episodes, day care and after care

Patient classification based on inpatient episode summary

One referral can lead to more episodes of care (new DBC for co-morbidity)

One classification per clinical episode

Outpatient-, day- and inpatient care integrated

Inpatient care and sometimes day care

Coding done during process by clinicians

Coding afterwards by medical record department or clinicians

Includes fee specialist Includes or excludes fee specialist

DBC cluster will be the result of a grouper

DRG is the result of a grouper

Documents

Department of Health, Welfare and Sport Transition of the Dutch health care system focused on hospital care May 26th 2005 Marc Soeters Maaike Prins Diagnosis