The Future of Hospitals in the Netherlands in 2015

RESEARCH QUESTIONS:
1. Financial structure

• Who is financing (externally)? How structured? Solidarity?
  
• Influence new insurance system? What in basic insurance and what should be additional insured?
  
• What is finance structure internally?
  
• What are the consequences of the integrations (fusions) of health insurance companies...buying power?
  
• Who pays the costs that are a result of life style induced illness? Where begins own responsibily and risk?
  
• Involvement government H or L?
  
• Percentage of GDPspend on healthcare?
  

2. Demand for hospital care
http://www.kiesbeter.nl/Home/Start.aspx

3. Supply side of hospital care

• Labour market for physicians, nurses
  
• What is development of technology and influence thereof on hospital care; what are costs involved?
  
• Care remains labour-intensive? Scarcity of labour? Costs involved?
  

4. Organization of hospital care

• Public owned vs private owned hospitals?
  
• Differentiated care (per indication, per type of patient)? Differentiated tariffs?
  
• Limitations to free market? Currently 'B-segment'
  
• Emergency care responsibility governments as oposite to elective care? How about 'cherry picking' or cross-subsidizing between DFCs?
  
• Other suppliers (e.g. private enterprises for diagnostics)?
  
• What are the consequences of the integrations (fusions) of hospitals with other hospitals and homes for the elderly (less and bigger hospitals, less choice where to go etc.)??
  
• In that matter: what will happen with prices when the free market for hospital care changes because of the integration of market parties
  
• Involvement government H or L?
  

5. Ethical debate

• At the the moment there is a (sort of) general opinion that we have to apply every possible technical solution to cure people, even when this is very expensive. This opinion will probably not hold because of rapid technical developments. What will happen? - change in public opinion?
  

• Role of QUALITY? A life year added in fair quality in the western world is allowed to cost appr. € 18.000

• Technological developments in genomics and biotechnology will imply a shift from cure to prevention - this implies another type of healthcare and a significant decrease in the number of hospital bed days. Uncertainty is what comes out of the ethical debate.

6. Other external factors

• MRSA ?
  

What are the driving forces for all these subjects?

BACKGROUND:
Medical cost and demand in healthcare are swelling. An intensifying dissatisfaction among patients, government officials, insurers, employers, clinicians and healthcare executives is noticeable. The soaring prices paid to treat the growing volumes of demanding, aging patients are prompting payers to search for more efficient ways of treatment and care. Next to that the government in Holland has introduced the new healthcare payment system with a new insurance system and diagnosis treatment combinations. The main aim of this transition is the development from a budget oriented system to a more market oriented health care system. The belief is that a market oriented system will create more incentives for efficiency, quality and innovation. Many hospitals in the Netherlands have to withstand those forces and the severe capital crunch they create. As many of our group have a certain affinity with the healthcare sector (from different angles: Insurer, pharmaceutical, hospital and client perspective) we formulated the following scenario definition. Scenario definition: ‘The future of hospitals in the Netherlands in 2020’ Main driving forces: There are a few driving forces (PWC, 1999) which create the severe capital crunch the hospitals in The Netherlands are getting in to.

2: The impact of E-health on the healthcare business;
 E-health will be used for transactions between suppliers, other providers, payers, regulators and patients;
 E-health will be used for information for patients and healthcare workers and will be used as a marketing and branding tool for the hospitals;
 E-health will be used for interaction between with providers and intermediaries.
3:The shift from cure to prevention due to new technologies like genomics and biotech advances
 Genomics will open markets for diagnostic testing, preventive medicine, follow up treatments and even support services such as lifestyle counselling.
 Life sciences and information technology will fuse into biotechnical discoveries in the decade ahead, restrained only by the financial purse strings of government agencies (like NWO), private foundations, pharmaceutical companies and informal investors.
4: The impact of the new healthcare financing system in the Netherlands
 The new (privatized) healthcare system will have it’s impact on the amount of services, the patients, the healthcare insurers, the intermediaries, the suppliers like pharmaceutical companies and the hospitals;
 The impact of the new market oriented financing system with the diagnosis treatment combinations.
5: Finally a driver we want to include in our scenario’s is the future scarcity of labor in the Netherlands
 The aging population will have it’s impact on the health care sector. It will be growing. At this moment about 300.000 people are working in the health care sector. But will there be the estimated necessary 600.000 workers in the future? Methodology: So far, we have identified four plausible drivers. In the further development of our project we will have to ‘dig into the facts’. We will do this by a thourough literature study. Gather the facts and figures and substantiate on our findings this far. Secondly, our intention is to have some in-depth interviews with some opinion leaders in the field of hospital care, farmaceutics and insurance. We wil speak with them about their expectations, and will try to verify our findings. These two angles (literature study and interviews) will be our solid academical ground in defining our scenario’s and the strategic possibilities as a result of the scenario’s we will try to define for this project.
References:  PricewaterhouseCoopers Healthcast 2010 – smaller world, bigger expectations, 1999  PricewaterhouseCoopers HealtCast Tactics: A blueprint for the future, 2002

DRIVING FORCES

• Increasing privatisation of hospitals
  
• Increase in health care costs
  
• Technology developmentleading to new diagnostic and treatment options
  
• The growing population of overweight people
  
• Aging population
  
• Increasing Neglect of the Elderly
  
• Increase in Stress of Adult Workers in The Netherlands
  
• Less governmental involvement
  
• Introduction managed care (cooperation hospital-health insurer)
  
• Patient empowerment
  
• Decreased role of general practitioner as 'gatekeeper'for hospital care
  
• Future shortage in healthcare workers effects availability hospital care negatively
  
• Providers will integrate foreward, setting up own clinics
  

Clustering driving forces

• Technology (genomics, biotechnology, E-health, medical technology)
• Free-market mechanisms
• Changing patient profiles (aging population, empowered patients, more morbidity and lifestyle)
• Ethical debate (to what extent does this inhibit innovation)

Draft scenario grid

SOURCES OF INFORMATION

• Healthcast 2010: Smaller world, Bigger Expectations. PWC. November 1999. [1]
• Healthcast Tactics: A Blueprint for the future. PWC. May 2002. [2]
• Stress, satisfaction and burnout among Dutch medical specialists. Mechteld R.M. Visser, Ellen M.A. Smets, Frans J. Oort, Hanneke C.J.M. de Haes
• Market in Need of Products That Address Key Concerns of Growing Patient Population and Rising Healthcare Costs; Developing New and Innovative Technologies is the Way Forward. September 6, 2005. PR Newswire Association LLC.
• Specialty Cardiac Hospitals Treat Less Severely Ill Patients Than Non-Specialty Hospitals . July 12, 2005 Tuesday 12:00 PM GMT. Business Wire, Inc