Upload
verity-harris
View
215
Download
1
Embed Size (px)
Citation preview
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
Department of Health, Welfare and Sport
Agenda
• Presentation on the transition of the Dutch health care system with focus on the hospital market (20 minutes)
• Questions
Department of Health, Welfare and Sport
presentation
• Problems with old system• Outline new health care system• Focus on hospital care and introduction of
DBCs
Department of Health, Welfare and Sport
Old system of health care
• Government regulated system:– prices/tariffs– Budgets– Capacity (hospitals)– Insurers obligated to contract all suppliers
of health care
Department of Health, Welfare and Sport
Problems
• large increases of budget in past years• But still shortage (waiting lists) and
complaints about quality
Department of Health, Welfare and Sport
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
Department of Health, Welfare and Sport
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
Department of Health, Welfare and Sport
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)
Department of Health, Welfare and Sport
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
Department of Health, Welfare and Sport
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
Department of Health, Welfare and Sport
What is a DBC?
• DBC: Diagnosis Treatment Combination
• Uniform defined health process description
• Description of the total health path
• Cost homogeneous and medical coherent
Department of Health, Welfare and Sport
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
Department of Health, Welfare and Sport
Scope DRG
GP Outpatient visit(s)
Clinical episodes
Homecare
GP
Rehab /Aftercare
Daycare
Department of Health, Welfare and Sport
GP Outpatient visit(s)
Clinical episodes
Homecare
GP
Rehab /Aftercare
Daycare
Scope DBC
Department of Health, Welfare and Sport
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