Realise vision on care: Just do it!

In the Netherlands we have a strong primary care. We need to be careful that we do not suffer from the dialectics of progress. Strengthening primary care can be a hindrance to integration with the specialist medical care. Other countries, then the Netherlands, are not familiar with the concepts primary (GP) and secondary care (hospital/specialist medical care). What matters is the coordination of care between the different professional groups under the direction of the GP or medical specialist. The right care should be given on the right place. Crucial is that the professional has no personal interest in the treatment of patients. In one way or another, a common interest should be created, by making a part of the funding dependent on the joint health gains. When thinking about a future vision on care, it is the trick to look into the future and releasing the present at the same time.

I wonder whether it is not wiser to reason from the content of care at first and then start to discuss where that care can be delivered at second? Thinking in terms of strengthening the primary care is incorrect in my opinion. Of course, it is important that the right care is provided on the right place, but it seems better to reason from the content, instead of deciding first where the care is given: primary care or secondary care.

It would be even better to take health gains as a starting point while thinking of the future health care. This requires a lot of data on treatments, outcomes, performance indicators, etc. In the Netherlands we have made a significant step in performance indicators in recent years.

In the U.S. there are already examples of health organisations who think from the principle of health benefits. A good example is the Kaiser Permanente (KP). Based on continuous research, they keep improving continuously. KP has listings of many patients and data. The processes are continuously monitored and improved. This  is something we (in the Netherlands) can learn from.

In various regions we (in the Netherlands) would like to give shape to this way of thinking, working and organizing care. Regional deals can be made among care providers and health insurers in order to provide the best possible quality of care. In this respect contract-arrangements can be made about the individual and collective quality of care to be provided (performance indicators), wherever possible on health gains and improvement. On the basis of demand of care and the care to be delivered, budgets could be divided.

To develop, monitor and continuously improve the quality of care provided, an independent regional quality agency is required. Such an office facilitates the preparation of (evidence-based) care programs, in which all relevant professional groups are participating. If the care programs are established on content, it will be considered/decided by whom care can be supplied at best (in terms of quality and cost).

The regional quality agency visitates, monitors and focuses on improving and supporting health care providers. The principle is shared savings. This means that savings partly diverts back to the professional groups, enabling them to innovate. The other part of the savings is for the insurers, so they can lower premiums, and in addition, the quality agency can be paid.

I would like to develop such a regional pilot with relevant health care providers and insurers in a region in the Netherlands in order to outline a joint panoramic view of the vision on regional care and start making a first step into the agreed direction. Just start and especially persevere, improve and adapt continually on all fronts. Together we step into this adventure, where sometimes ways have to be paved. But if we do not just start without putting over the helm, I'm afraid that nothing crucial will change. I would dare to face this challenge. So I say: Just do it!

Yvonne Kemenade

yvankemenade@wxs.nl