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How to cope with rising demand for primary care in The Netherlands in the future.
Bakker, D. de, Sluijs, E., Hingstman, L., Treurniet, H., Polder, J. How to cope with rising demand for primary care in The Netherlands in the future. European Journal of Public Health: 2005, 15(suppl. 1) 50. Abstract. 13th Annual EUPHA Meeting "Promoting the public's health: reorienting health policies, linking health promotion and health care", Graz, 10-12 November 2005.
Background: Demographic and epidemiological projections indicate that a substantial increase of
primary care demand is to be expected, especially for general practice care, pharmaceutical
services, and home care. There are worries whether this rising demand can be curbed. A quantitative
analysis was made of future supply and an analysis of measures to solve capacity problems.Methods:
(i) Analysis of trends in the supply of primary care workers (GPs, pharmacists, physiotherapists,
midwives, community nurses, home helps, social workers, and primary care psychologists). Based on
these, projections are made of supply in 2020 accounting for trends in part-time working, inflow,
and outflow into professions. These projections are confronted with expected demand. (ii) Literature
survey of possible measures to improve the match between supply and demand within primary care:
lowering demand by promoting prevention, lowering utilization by co-payments, measures to enlarge
inflow and to reduce outflow into professions, task delegation, task reshuffling between
professions, and better collaboration. Results: Shortages of general practitioners can be foreseen.
Although the supply is rising with 11.5% in the period 2005–2020, the demand is expected to grow
with 13–20%. Furthermore, shortages can be foreseen in the number of home helps and community
nurses. For the other disciplines, no shortages are foreseen at this moment. Of the proposed
measures to reduce shortages, task delegation in general practice has proved to contribute to an
efficient provision of care. Delegation of tasks to practice nurses has contributed to quality of
care for the chronically ill and a bit to reducing GP’s workload. Strengthening of primary mental
health care has also reduced the pressure of work on general practice. There is no scientific
evidence about the effects of other measures yet. Conclusions: Capacity problems can be foreseen for
general practice in the future but these are substantially less than in earlier ramifications. Many
of the measures which are partly already implemented do not rest on scientific evidence that they
have effect. Besides that several have the negative side-effect that they contribute to
fragmentation of primary care over more care providers and organizations. It is recommended that new
measures should be assessed on their contribution to coherent and continuous primary care.
(aut.ref.)
primary care demand is to be expected, especially for general practice care, pharmaceutical
services, and home care. There are worries whether this rising demand can be curbed. A quantitative
analysis was made of future supply and an analysis of measures to solve capacity problems.Methods:
(i) Analysis of trends in the supply of primary care workers (GPs, pharmacists, physiotherapists,
midwives, community nurses, home helps, social workers, and primary care psychologists). Based on
these, projections are made of supply in 2020 accounting for trends in part-time working, inflow,
and outflow into professions. These projections are confronted with expected demand. (ii) Literature
survey of possible measures to improve the match between supply and demand within primary care:
lowering demand by promoting prevention, lowering utilization by co-payments, measures to enlarge
inflow and to reduce outflow into professions, task delegation, task reshuffling between
professions, and better collaboration. Results: Shortages of general practitioners can be foreseen.
Although the supply is rising with 11.5% in the period 2005–2020, the demand is expected to grow
with 13–20%. Furthermore, shortages can be foreseen in the number of home helps and community
nurses. For the other disciplines, no shortages are foreseen at this moment. Of the proposed
measures to reduce shortages, task delegation in general practice has proved to contribute to an
efficient provision of care. Delegation of tasks to practice nurses has contributed to quality of
care for the chronically ill and a bit to reducing GP’s workload. Strengthening of primary mental
health care has also reduced the pressure of work on general practice. There is no scientific
evidence about the effects of other measures yet. Conclusions: Capacity problems can be foreseen for
general practice in the future but these are substantially less than in earlier ramifications. Many
of the measures which are partly already implemented do not rest on scientific evidence that they
have effect. Besides that several have the negative side-effect that they contribute to
fragmentation of primary care over more care providers and organizations. It is recommended that new
measures should be assessed on their contribution to coherent and continuous primary care.
(aut.ref.)
Background: Demographic and epidemiological projections indicate that a substantial increase of
primary care demand is to be expected, especially for general practice care, pharmaceutical
services, and home care. There are worries whether this rising demand can be curbed. A quantitative
analysis was made of future supply and an analysis of measures to solve capacity problems.Methods:
(i) Analysis of trends in the supply of primary care workers (GPs, pharmacists, physiotherapists,
midwives, community nurses, home helps, social workers, and primary care psychologists). Based on
these, projections are made of supply in 2020 accounting for trends in part-time working, inflow,
and outflow into professions. These projections are confronted with expected demand. (ii) Literature
survey of possible measures to improve the match between supply and demand within primary care:
lowering demand by promoting prevention, lowering utilization by co-payments, measures to enlarge
inflow and to reduce outflow into professions, task delegation, task reshuffling between
professions, and better collaboration. Results: Shortages of general practitioners can be foreseen.
Although the supply is rising with 11.5% in the period 2005–2020, the demand is expected to grow
with 13–20%. Furthermore, shortages can be foreseen in the number of home helps and community
nurses. For the other disciplines, no shortages are foreseen at this moment. Of the proposed
measures to reduce shortages, task delegation in general practice has proved to contribute to an
efficient provision of care. Delegation of tasks to practice nurses has contributed to quality of
care for the chronically ill and a bit to reducing GP’s workload. Strengthening of primary mental
health care has also reduced the pressure of work on general practice. There is no scientific
evidence about the effects of other measures yet. Conclusions: Capacity problems can be foreseen for
general practice in the future but these are substantially less than in earlier ramifications. Many
of the measures which are partly already implemented do not rest on scientific evidence that they
have effect. Besides that several have the negative side-effect that they contribute to
fragmentation of primary care over more care providers and organizations. It is recommended that new
measures should be assessed on their contribution to coherent and continuous primary care.
(aut.ref.)
primary care demand is to be expected, especially for general practice care, pharmaceutical
services, and home care. There are worries whether this rising demand can be curbed. A quantitative
analysis was made of future supply and an analysis of measures to solve capacity problems.Methods:
(i) Analysis of trends in the supply of primary care workers (GPs, pharmacists, physiotherapists,
midwives, community nurses, home helps, social workers, and primary care psychologists). Based on
these, projections are made of supply in 2020 accounting for trends in part-time working, inflow,
and outflow into professions. These projections are confronted with expected demand. (ii) Literature
survey of possible measures to improve the match between supply and demand within primary care:
lowering demand by promoting prevention, lowering utilization by co-payments, measures to enlarge
inflow and to reduce outflow into professions, task delegation, task reshuffling between
professions, and better collaboration. Results: Shortages of general practitioners can be foreseen.
Although the supply is rising with 11.5% in the period 2005–2020, the demand is expected to grow
with 13–20%. Furthermore, shortages can be foreseen in the number of home helps and community
nurses. For the other disciplines, no shortages are foreseen at this moment. Of the proposed
measures to reduce shortages, task delegation in general practice has proved to contribute to an
efficient provision of care. Delegation of tasks to practice nurses has contributed to quality of
care for the chronically ill and a bit to reducing GP’s workload. Strengthening of primary mental
health care has also reduced the pressure of work on general practice. There is no scientific
evidence about the effects of other measures yet. Conclusions: Capacity problems can be foreseen for
general practice in the future but these are substantially less than in earlier ramifications. Many
of the measures which are partly already implemented do not rest on scientific evidence that they
have effect. Besides that several have the negative side-effect that they contribute to
fragmentation of primary care over more care providers and organizations. It is recommended that new
measures should be assessed on their contribution to coherent and continuous primary care.
(aut.ref.)
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