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• W273335331 abstract "The Netherlands has a high-quality health care system, but, like its counterparts in other developed nations, it faces tremendous strains. An aging population has put pressure on the budget (Exhibit 1). The public demands access to modern treatments and will no longer accept impersonal care and long waiting lists. In the struggle to make ends meet, the system pays too much attention to short-term curative care and too little to prevention. Moreover, many frustrated health care practitioners are leaving the system and recruitment has become rather more difficult (Exhibit 2). McKinsey's Amsterdam office teamed up in the fall of 1999 with three Dutch health care experts [1] to look for a better way. The resulting study concludes that traditional approaches can't close the gap between growing demand and restricted supply; a radical transformation is required. The team proposed a system that would replace top-down regulation with demand-driven self-regulation. Citizens would take more responsibility for health care, and doctors would be responsible for the health care costs of their patients. Such a system is expected to deliver significant (but as yet unquantified) gains in productivity. All Dutch citizens have access to excellent essential health care services, and their cost is relatively low, largely as a result of limits on the supply of beds, admissions, doctors, and budgets (Exhibit 3, on the next spread). Patients usually consult their general practitioners before going to specialists. Public, employer-paid, or private insurance covers everyone. Since this system is overburdened, however, the McKinsey study suggests a self-regulating alternative that resembles a roundabout. Roundabouts, which let drivers themselves regulate the flow of traffic, are much more effective than are traffic lights, which deal with the supply--that is, the anticipated number of vehicles. To take responsibility for health care, people need freedom of choice, information on the quality of care and on alternatives, and adequate financial resources, The study argues that individuals should be free to choose and change their doctors-a right that they now have in theory but can exercise only with difficulty, since very little information about the performance of doctors and hospitals is available to them. The team recommends that citizens receive access to such information (particularly evaluations by patients and professional peers), for it is this, together with the freedom to switch, that will force doctors to deliver the best personal care to keep patients in their practices. Of course, patients need financial resources as well as information. Because each individual's requirements are different, the model is somewhat complex in this respect. The people of the Netherlands attach great value to social solidarity, so the team believes that the government should continue to decide what kind of care is essential and how large the national budget for it should be. The team also proposes that the government should use such parameters as age, sex, and medical histories to allocate a share of this national budget to each citizen, bypassing the insurance companies. A healthy youngster would therefore have a significantly lower allocation than a 70-year-old diabetes patient. Essential health care spending would be paid for from this budget; additional care could be bought separately from doctors or covered by supplementary insurance at the patient's expense. In many cases, individuals would be able to direct their own budgets--for example, diabetics who know exactly which provisions to buy and where to buy them would participate in a purely self-regulated market. But healthy people who become seriously ill face two challenges: they may not have the knowledge or desire to shop for the best services, and their budgets, based on their previous health status, will be too low. To overcome these challenges, the team proposed that all patients assign their budgets to freely chosen doctors responsible for orchestrating all of their health care. …" @default.
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• W273335331 date "2000-03-22" @default.
• W273335331 modified "2023-09-26" @default.
• W273335331 title "Rethinking Dutch Health Care" @default.
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