Preventive health care in The Netherlands

Description:

The cost of healthcare is rising so much that the system based on solidarity is in danger. Preventive healthcare is healthcare focussed on prevention of diseases. There are three levels:

• Primairy prevention: The prevention of disease. Healthy food prevents overweight and obesities. Preventive healthcare includes information and education, as also prophylactic regulation, hygiene in food preparation and safety regulation.
  
• Secondary prevention: To detect early signs of deformation or diseases in an early stage. Medical screening of babies and children are forms of secondary prevention.
  
• Tertiary prevention: After a disease occurred several procedures are taken to prevent diseases from returning. Changing lifestyle, eating habits is i.e. prevent a recidive of a heart attack.
  
  

Collective prevention is focussed on the whole population or on a segment. It is defined in the law on collective prevention and healthcare.

Cost of individual prevention should be covered by the health insurance law. Next to the responsibility of the person himself it is also the responsibility of the health providers and health insurers, in the same way they are responsible for providing curative healthcare.

In 2003 12,5 billion Euros was spend on prevention. This includes all cost in and outside healthcare. This means increasing the health of the population and welfare, but this also includes garbage removal and placing noise panes. In healthcare itself only 2,6 billion Euros are spend. 83% is spent on health protection, 16% on health increase and 1% on health protection regulation. Medicine to prevent cholesterol and blood pressure, job related prevention and prevention of psychological diseases are accountable to healthcare increase, it is not known which part is spent on prevention, healthcare protection (risk evaluation) and healthcare increase (training in use of technical assistance) The costs are increasing with increasing age due to population screening and use of cholesterol and blood pressure decreases.

Almost 1,6% of the whole budget for healthcare is labelled for ‘Prevention and Healthcare’. A lot of these expenses like programs to activate people are financed outside healthcare. There is a shift from financing prevention by the finance department to the healthcare department.
20000 – 80000 Euro per “won” year to live, corrected for quality of life (QALY) is the variable threshold to determine when to intervent with a prevention program/ activity. The Council sets this rule for Public Health and Health Care (RVZ).
Health insurance companies are new stakeholders in prevention. Cost of care will decrease when more is spent on prevention. Some preventive intervention is defined in the basic health insurance, which is equal for all Dutch citizens. Secondly, people can choose to insure other forms of prevention themselves, in the added insurance policy. And in the third place there are prevention activities of insurance companies that are provided outside the insurance policies.

A lot of unhealthy life habits are important risk factors, for example cardiac diseases, chronically pulmonary diseases and diabetes. Integrated care for diabetes including interventions on increasing activity and losing weight. Complications are prevented or delayed.

Another example is the development and evaluation of exercise interventions in COPD patients. Physical exercise in combination with the medical treatment gives better outcomes of medical results and quality of life.

For prevention of chronically disease risk profiling and prevention strategies are promising tools.

In 2006 five focus areas are defined smoking, overweight, alcohol, depression and diabetes. More than 50% of all premiums paid is to: cure diabetes type 2, coronary heart disease, stroke, heart failure and forms of cancer caused by smoking, alcohol, overweight, unhealthy food, limited activity or combinations of those. Only a fraction is spent on prevention.

“Human resource” protection (human capital) is seen as an important social function of healthcare. A lot is gained focusing more on prevention than on curing.

Enabler:

• Integral health programs
  
• Finance interventions supporting prevention and chain care
  
• Quality of the prevention programs
  
• Prevention in the media
  
• Self tests
  
• Openness of people to doctors
  
• Focus on safety in i.e. manufacturing
  
• More providers of preventive care
  
• More awareness in education for prevention
  
• Empowerment of the individual for prevention
  
• Self-management
  
• IT-support systems
  

Inhibator:

• Strict finance regulations
  
• Dispersed budgets over different departments
  
• Limitation of budget
  
• No urgency felt
  
• Urbanisation
  

Paradigms:

Prevention can be seen as an investment, like innovation. It could lower the cost of healthcare a lot in the short run and long run. And will increase the quality of life.

Experts:

• Healthcare providers
  
• The government, the departments of the ministry of health, welfare and sports,
  
• The city councils,
  
• The public health department of the city (GGD),
  
• Health insurance companies
  

Timing:

The sooner the better; to reduce cost in crisis time and to prevent more people (human capital) drift into unhealthy lifestyles leading to more diseases and cost.

Web resources:

www.RIVM.nl
www.ZN
www.vws.nl
www.cpb.nl
www.cbs.nl