The care receiver is being given a voice

The end goal of the stimulation of market forces, disappearance of waiting lists and the management of ever-increasing costs have not become reality yet. However increased competition and a better balance between supply and demand have arisen. The government is also enforcing funding based on achieved performance. This has resulted in greater transparency, giving the care receiver greater insight. More freedom of choice for the insured party/patient also ensures that the existing focus on Cost Management changes irrevocably to a focus on quality. The balance between handling an increased expenditure on one hand and value creation on the other, is still a topical issue. Simply too much is at stake for total liberalisation.

In the future, the care receiver will be spending a substantial portion of their income on healthcare. Therefore, it is only fair that they receive a say in the matter. Patients will choose where they wish to be treated and by whom; they are well informed, demanding (care mediation) and critical about received care (dramatic increase of second opinions). They also choose their own care providers, based on the reputation and quality of the provider. If necessary, they choose to accelerate their treatment by using private clinics or going abroad. In such cases, information is gathered via internet, but the Healthcare insurers also provide advice as this has become more commonplace and they have adapted their services to accommodate this. Healthcare management will continue to exist, but the quality (as opposed to the price) of the care providers will become the deciding factor. The care receiver will be satisfied with increased co-operation within the healthcare chain. Focus will shift to the patients’ disease and no longer rests on the logistics between the various Healthcare providers. The entire healthcare chain will be focussed on providing care receivers with the optimum care within an acceptable time span, from prevention to the initial screening up to revalidation, monitoring and after care.

Healthcare providers: forced to become more commercial
Entrepreneurship is demanded from the care providers. An end has come to systems with fixed hospital budgets and the introduction of complete performance funding compels hospitals to rationalise less successful activities as well as select a clear profile (national or regional, general or specialist, co-operating within specific areas of speciality or co-operating with other hospitals). Integration within the healthcare chain, such as a merger with a Healthcare insurer, is also worth the consideration. Performance contracts enforce collaboration between new parties aimed at offering efficient and high quality care at a market related price. Digital patient information (heralding to the EPD, the Electronic Patient Dossier) and improvements in logistics, amongst other things, are used to this end. The cost of procedures and treatments are made public and production agreements are dissolved, leading to increased competition. Parties are competing for the patients’ favour, the patient basing their preference on the best quality care. This demands complete transparency on performance, particularly regarding volume (experience) and quality. Marketing and strategies incorporating advanced communication methods with customers support this process.

A new role for Healthcare insurance providers
As the private financiers of the Healthcare market, Healthcare insurance companies remain a powerful party. In the past, they acted as clever buyers who brought an efficient standard package to the market on the largest possible scale. They will have to let go of this role if they wish to remain competitive. The handful of remaining insurers will have to differentiate their offerings in order to draw new customers. Examples of such differentiation are the additional care packages that they offer or more flexible terms for collective insurance agreements or accounts. They are also able to differentiate in the service they deliver to their customers, advice and additional services like preventative care and medical checkups for example. In their new role as directors and health advisors, insurers are open to co-operation, chain healthcare and innovation. Good information provision is essential, also when contracting the appropriate Healthcare partners. Interaction with the insured parties, as is the case with care mediation currently, will become quite common in future and is likely to be institutionalized. Logically, this requires substantial changes to the systems and processes.

The government: much needed watchdog
As public financier, the government has the task of ensuring that tax money is spent as efficiently as possible, while accessibility may not suffer as a result. The government is anticipating a continuous rise in demand. In most other markets supply and demand adapt to each other at some point in time, but the Healthcare market seems an exception to this rule due to aging of the general population. Increased numbers of senior citizens with longer life expectancies on average, a shift from treatments with a short average duration to treatments with a longer average duration, more chronic diseases on average and increased numbers of illnesses that touch on mental healthcare territory are all factors leading to cost escalation, causing a lot of pressure on the social insurances. To ease the pain, the government is actively investing in prevention programmes. However, cost reduction measures and a watchful eye need to be kept on the Healthcare industry to keep matters on track.

Co-operating for greater efficiency gains
The inertia created by the stimulation of market forces within the Healthcare industry has triggered a stream of new developments. All parties are pressured to make the necessary adjustments. Both insurers and hospitals still have the inclination to operate as separate islands as they did in the past. Great benefits could be reaped from increased co-operation as this generates greater efficiency and quality improvements. Once implemented, healthcare within the chain has to deliver cost advantages between insurers and care providers and amongst care providers themselves. Two important prerequisites exist here: exchanging correct and up-to-date information between various parties as well as being prepared to accept the necessary innovation.

The major trends

• Moving from supply-driven to demand-driven
• Increased demand, movement from cure to care as result of general obsolescense in the Netherlands
• Affordability, quality and accessibility remain the most important themes
• Introduction of funding in relation to achieved performance to stimulate the market forces
• Much to be profited from co-operation
• Transparency is key
• Optimized logistics, communications and business processes offer substantial potential for improvement
• The government remains in the loop