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Integrated care: achieving better coordination of care for the chronically ill. Lessons from The Netherlands
bundled-payment initiative.
Dijk, C. van, Raams, J., Schut, E., Baan, C., Struijs, J., Vrijhoef, B., Wildt, J.E. de, Bakker, D. de. Integrated care: achieving better coordination of care for the chronically ill. Lessons from The Netherlands
bundled-payment initiative. European Journal of Public Health: 2013, 23(Suppl. 1), p. 142-143. Abstract. 6th European Public Health Conference: Health in Europe: are we there yet? Learning from the past, building the future. 13-16 November 2013, Brussel.
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Background: In 2010, a bundled payment system for diabetes care, COPD care and vascular risk management was introduced nationwide in The Netherlands. In the bundled payment system, are for thesepatients is organised by a care group that provides general and more specialised care for the specific disease, and that negotiates a lump sum for each patient with the health insurer. Care groups can either provide care themselves or sub-contract other providers. Included services within the care program are based on national disease specific standards. Aim of the bundled payment system is to improve care, by among others stimulating multidisciplinary collaboration between health care providers. In this presentation, experiences with bundled payment after two and half year introduction are discussed. Methods: Experiences with the bundled payment system for chronic care were based on all available studies on bundled payment in The Netherlands until 8 May 2012 and also included studies on the experimental period for diabetes care (2006-2010). Most studies had a focus on diabetes care. Results: Small positive effect on the quality of care were found for diabetes patients in the bundled payment system, although effects largely vary between care groups. Within the bundles payment system, a lower proportion of diabetes patients was treated in hospitals, but hospital costs did not decrease. Bundled payment for chronic care involved also extra investment costs in primary care (E400 per diabetes patient). Patients were unaware of being included in a program and selfmanagement and individual care plans were underdeveloped. Not all preconditions for optimal functioning of the bundled payment system were fulfilled. The transparency system did not function properly and there was a lack of steering by health insurers on double payments. Care groups had a monopolistic position, while sub-contractors were in a weak position. Despite these issues around competition, no evidence was found for risk selection. Conclusions: It is too early for a final assessment of bundled payments in The Netherlands. For bundled payments to succeed, care groups must fulfill higher requirements with regard to the preconditions and patients’ involvement should be guaranteed better.
Background: In 2010, a bundled payment system for diabetes care, COPD care and vascular risk management was introduced nationwide in The Netherlands. In the bundled payment system, are for thesepatients is organised by a care group that provides general and more specialised care for the specific disease, and that negotiates a lump sum for each patient with the health insurer. Care groups can either provide care themselves or sub-contract other providers. Included services within the care program are based on national disease specific standards. Aim of the bundled payment system is to improve care, by among others stimulating multidisciplinary collaboration between health care providers. In this presentation, experiences with bundled payment after two and half year introduction are discussed. Methods: Experiences with the bundled payment system for chronic care were based on all available studies on bundled payment in The Netherlands until 8 May 2012 and also included studies on the experimental period for diabetes care (2006-2010). Most studies had a focus on diabetes care. Results: Small positive effect on the quality of care were found for diabetes patients in the bundled payment system, although effects largely vary between care groups. Within the bundles payment system, a lower proportion of diabetes patients was treated in hospitals, but hospital costs did not decrease. Bundled payment for chronic care involved also extra investment costs in primary care (E400 per diabetes patient). Patients were unaware of being included in a program and selfmanagement and individual care plans were underdeveloped. Not all preconditions for optimal functioning of the bundled payment system were fulfilled. The transparency system did not function properly and there was a lack of steering by health insurers on double payments. Care groups had a monopolistic position, while sub-contractors were in a weak position. Despite these issues around competition, no evidence was found for risk selection. Conclusions: It is too early for a final assessment of bundled payments in The Netherlands. For bundled payments to succeed, care groups must fulfill higher requirements with regard to the preconditions and patients’ involvement should be guaranteed better.