Background: Generally, a significant portion of healthcare spending consists of out-of-pocket (OOP) expenses. Patients indicate that, in practice, there are often some OOP expenses, incurred when they receive medical care, which are unexpected for them and should have been taken into account when deciding on a course of action. Patients are often reliant on their GP and may, therefore, expect their GP to provide them with information about the costs of treatment options, taking into consideration their individual insurance plan. This also applies to the Netherlands, where OOP expenses increased rapidly over the years. In the current study, we observed the degree to which matters around patients' insurance and OOP expenses are discussed in the Netherlands, using video recordings of consultations between patients and GPs. Methods: Video recordings were collected from patient-GP consultations in 2015-2016. In 2015, 20 GPs and 392 patients from the eastern part of the Netherlands participated. In 2016, another eight GPs and 102 patients participated, spread throughout the Netherlands. The consultations were coded by three observers using an observation protocol. We achieved an almost perfect inter-rater agreement (Kappa = .82). Results: In total, 475 consultations were analysed. In 9.5% of all the consultations, issues concerning patients' health insurance and OOP expenses were discussed. The reimbursement of the cost of medication was discussed most often and patients' current insurance and co-payments least often. In some consultations, the GP brought up the subject, while in others, the patient initiated the discussion. Conclusions: While GPs may often be in the position to provide patients with information about treatment alternatives, few patients discuss the financial effects of their referral or prescription with their GP. This result complies with existing literature. Policy makers, GPs and insurers should think about how GPs and patients can be facilitated when considering the OOP expenses of treatment. There are several factors why this study, analysing video recordings of routine GP consultations in the Netherlands, is particularly relevant: Dutch GPs play a gatekeeper function; OOP expenses have increased relatively swiftly; and patients have both the right to decide on their treatment, and to choose a provider.
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Abstract Background: Many countries in Europe have implemented managed competition and patient choice during the last decade. With the introduction of managed competition, health insurers also became an important stakeholder. They purchase services on behalf of their customers and are allowed to contract healthcare providers selectively. It has, therefore, become increasingly important to take one's insurance into account when choosing a provider. There is little evidence that patients make active choices in the way that policymakers assume they do. This research aims to investigate, firstly, the role of patients in choosing a healthcare provider at the point of referral, then the role of the GP and, finally, the influence of the health insurer/insurance policies within this process. Methods: We videotaped a series of everyday consultations between Dutch GPs and their patients during 2015 and 2016. In 117 of these consultations, with 28 GPs, the patient was referred to another healthcare provider. These consultations were coded by three observers using an observation protocol which assessed the role of the patient, GP, and the influence of the health insurer during the referral. Results: Patients were divided into three groups: patients with little or no input, patients with some input, and those with a lot of input. Just over half of the patients (56%) seemed to have some, or a lot of, input into the choice of a healthcare provider at the point of referral by their GP. In addition, in almost half of the consultations (47%), GPs inquired about their patients' preferences regarding a healthcare provider. Topics regarding the health insurance or insurance policy of a patient were rarely (14%) discussed at the point of referral. Conclusions: Just over half of the patients appear to have some, or a lot of, input into their choice of a healthcare provider at the point of referral by their GP. However, the remainder of the patients had little or no input. If more patient choice continues to be an important aim for policy makers, patients should be encouraged to actively choose the healthcare provider who best fits their needs and preferences.
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From Narcis.nl :" Patients with substance use disorder (SUD) are frequently suffering from co-occurring somatic disorders, increasing the risk of mortality. Somatic health care utilization (sHCU) often remains unknown to the physician during SUD treatment. This paper analyses sHCU and associated costs among patients in SUD treatment compared to matched, non-substance dependent controls. METHODS: Health care utilization data on 4972 SUD patients were matched to 19,846 controls by gender, birth year and ethnic origin. Subcategories of patients were formed based on SUD and on co-morbid psychiatric disorder. Data on sHCU during the year prior to the last treatment contact (the 'index date') for both patients and their matched controls were extracted from a health insurance database. RESULTS: Patients had a higher sHCU (with increased associated costs) than controls, especially when alcohol dependence was involved. In particular, sHCU for cardiovascular, respiratory, infectious diseases, injuries and accidents was increased among patients. However, the use of preventive medication, such as lipid-lowering drugs, is lower among SUD patients. Co-morbidity of psychiatric disorders led to further increase of sHCU, whereas patients with comorbid non-affective psychotic disorder (NAPD) showed lower sHCU and costs. CONCLUSION: Patients with SUD overall have a high sHCU, associated with high costs. There are indications that SUD patients have less access to preventive medication. Patients with comorbid NAPD are at risk of possible underutilization of somatic health care. Furthermore, we conclude that these larger administrative databases allow for comparisons between various diagnostic categories."
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Do individual characteristics influence how the quality of work is related to the use of a workflow management system (WFM) in a Dutch social insurance organisation? This key question is addressed in this paper. Building upon DeLone and McLean’s model, we investigated the effects of gender, age, education, system experience and computer skills on the relationship between the level of user satisfaction with a WFM system and the perceived quality of work. The expected effects of individual characteristics were tested using survey data collected from 143 end users of a large Dutch social insurance organisation that recently deployed a WFM system. The results of the regression analysis show that: 1 user satisfaction has a positive relationship with quality of work 2 age has a significant moderating influence on the perceived quality of work 3 gender and system experience have no moderating effects 4 education and system computer skills (as individual characteristics) had a degree of moderating effects. These results imply that it is valuable to focus on older employees when deploying information technology as WFM systems, i.e., by improving their computer skills in particular.
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Aim: Research has revealed higher risks of somatic problems among patients with non-affective psychotic disorders (NAPD) compared to the general population. The aim of this study was to examine whether NAPD patients also show increased somatic health care utilization compared to personally-matched controls without a psychiatric diagnosis and patients with unipolar depression, anxiety disorder or bipolar disorder. Methods: Data from a large Health Insurance agency were used to analyze prescribed somatic medication, general practitioner consultations, and treatment by a somatic specialist. Results: Patients with NAPD showed serious somatic under treatment, which was associated with older age and longer illness duration. Conclusion: In view of the high risk on natural death causes among patients with NAPD, our data indicate under treatment for physical disorders, especially at older age and with longer duration of the mental disorder.
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Background Literature on self-management innovations has studied their characteristics and position in healthcare systems. However, less attention has been paid to factors that contribute to successful implementation. This paper aims to answer the question: which factors play a role in a successful implementation of self-management health innovations? Methods We conducted a narrative review of academic literature to explore factors related to successful implementation of self-management health innovations. We further investigated the factors in a qualitative multiple case study to analyse their role in implementation success. Data were collected from nine self-management health projects in the Netherlands. Results Nine factors were found in the literature that foster the implementation of self-management health innovations: 1) involvement of end-users, 2) involvement of local and business partners, 3) involvement of stakeholders within the larger system, 4) tailoring of the innovation, 5) utilisation of multiple disciplines, 6) feedback on effectiveness, 7) availability of a feasible business model, 8) adaption to organisational changes, and 9) anticipation of changes required in the healthcare system. In the case studies, on average six of these factors could be identified. Three projects achieved a successful implementation of a self-management health innovation, but only in one case were all factors present. Conclusions For successful implementation of self-management health innovation projects, the factors identified in the literature are neither necessary nor sufficient. Therefore, it might be insightful to study how successful implementation works instead of solely focusing on the factors that could be helpful in this process.
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What does this paper add to existing knowledge? • This study provides insight into the severity of the problem. It demonstrates the differences in risk factors and OHRQoL between patients diagnosed with a psychotic disorder (first-episode) and the general population. • A negative impact on OHRQoL is more prevalent in patients diagnosed with a psychotic disorder (first-episode) (14.8%) compared to the general population (1.8%). • Patients diagnosed with a psychotic disorder (first-episode) have a considerable increase in odds for low OHRQoL compared to the general population, as demonstrated by the odds ratio of 9.45, which supports the importance of preventive oral health interventions in this group. What are the implications for practice? • The findings highlight the need for oral health interventions in patients diagnosed with a psychotic disorder (first-episode). Mental health nurses, as one of the main health professionals supporting the health of patients diagnosed with a mental health disorder, can support oral health (e.g. assess oral health in somatic screening, motivate patients, provide oral health education to increase awareness of risk factors, integration of oral healthcare services) all in order to improve the OHRQoL.
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Aim: Research has revealed higher risks of somatic problems among patients with non-affective psychotic disorders (NAPD) compared to the general population. The aim of this study was to examine whether NAPD patients also show increased somatic health care utilization compared to personally-matched controls without a psychiatric diagnosis and patients with unipolar depression, anxiety disorder or bipolar disorder. Methods: Data from a large Health Insurance agency were used to analyze prescribed somatic medication, general practitioner consultations, and treatment by a somatic specialist. Results: Patients with NAPD showed serious somatic under treatment, which was associated with older age and longer illness duration. Conclusion: In view of the high risk on natural death causes among patients with NAPD, our data indicate under treatment for physical disorders, especially at older age and with longer duration of the mental disorder. Presentatie voor UMCU Psychiatrie All-in 24 oktober 2017
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Background: Early childhood caries is considered one of the most prevalent diseases in childhood, affecting almost half of preschool-age children globally. In the Netherlands, approximately one-third of children aged 5 years already have dental caries, and dental care providers experience problems reaching out to these children. Objective: Within the proposed trial, we aim to test the hypothesis that, compared to children who receive usual care, children who receive the Toddler Oral Health Intervention as add-on care will have a reduced cumulative caries incidence and caries incidence density at the age of 48 months. Methods: This pragmatic, 2-arm, individually randomized controlled trial is being conducted in the Netherlands and has been approved by the Medical Ethics Research Board of University Medical Center Utrecht. Parents with children aged 6 to 12 months attending 1 of the 9 selected well-baby clinics are invited to participate. Only healthy children (ie, not requiring any form of specialized health care) with parents that have sufficient command of the Dutch language and have no plans to move outside the well-baby clinic region are eligible. Both groups receive conventional oral health education in well-baby clinics during regular well-baby clinic visits between the ages of 6 to 48 months. After concealed random allocation of interventions, the intervention group also receives the Toddler Oral Health Intervention from an oral health coach. The Toddler Oral Health Intervention combines behavioral interventions of proven effectiveness in caries prevention. Data are collected at baseline, at 24 months, and at 48 months. The primary study endpoint is cumulative caries incidence for children aged 48 months, and will be analyzed according to the intention-to-treat principle. For children aged 48 months, the balance between costs and effects of the Toddler Oral Health Intervention will be evaluated, and for children aged 24 months, the effects of the Toddler Oral Health Intervention on behavioral determinants, alongside cumulative caries incidence, will be compared. Results: The first parent-child dyads were enrolled in June 2017, and recruitment was finished in June 2019. We enrolled 402 parent-child dyads. Conclusions: All follow-up interventions and data collection will be completed by the end of 2022, and the trial results are expected soon thereafter. Results will be shared at international conferences and via peer-reviewed publication.
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The main objective of this report is to analyse and inform about international labour mobility, particularly within Europe, from the perspective of the Dutch Health and Social Care Sector. The report starts by describing the introduction of a new care system in The Netherlands. The government does not participate directly in the actual provision of care. This is a task principally for private care suppliers. Furthermore, the legal position of the Health and Social Care professions, regulated through the Individual Health Care Professions Act, and questions like the international recognition of degrees and the evaluation of foreign diplomas are discussed. This is followed by a clarification of the Dutch education system, particularly, relating to the study of medicine, nursing education and social work education. Subsequently, some core data on the ageing Dutch population are presented. The grey pressure increases and this will have an impact on health spending, health support and the future labour market. Then what follows is a description of the development of employment in the Dutch Health and Social Care Sector, per branch as well as the professions that are engaged in it. The general picture, at this moment, is that the Health and Social Care labour market is reasonably in balance. This trend will continue in the near future; shortages are expected only in the long term. All research done on the subject indicates that international mobility of medical and social professionals is still low in the Netherlands. The question remains whether a more active recruitment policy would be a solution for the expected long term shortages. The report concludes with a look at recruitment policy and some of its developments at the global, national and local level.
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