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152 Musculoskeletal & Neurological Rehabilitation KCE reports 57 A general search was done the last trimester of 2005 and the first trimester of 2006 using the related meshterms: "Organization and Administration"[MeSH] OR "Professional Review Organizations"[MeSH] OR "Organizations, Nonprofit"[MeSH] OR "Health Planning Organizations"[MeSH] OR "Health Maintenance Organizations"[MeSH] OR "Health Care Economics and Organizations"[MeSH] OR "Managed Care Programs"[MeSH] OR "Risk Adjustment"[MeSH] OR "Organizational Case Studies"[MeSH] OR "Health Expenditures"[MeSH] OR "European Union"[MeSH]) AND ("Rehabilitation"[MeSH] OR "rehabilitation"[Subheading] OR "Rehabilitation Nursing"[MeSH] OR "Rehabilitation Centers"[MeSH] OR "Rehabilitation of Speech and Language Disorders"[MeSH] OR "Rehabilitation, Vocational"[MeSH] OR "Activities of Daily Living"[MeSH] OR "Treatment Outcome"[MeSH]) For each country a more specific search was done introducing search terms for multiple sclerosis, spinal cord injury, total hip replacement, stroke and lower extremity amputation (see Appendix to chapter 8). 8.2.3 Comments Taking into account the research question (specific organisational information on the rehabilitation sector) this search strategy is not offering a lot of relevant results. The medical peer reviewed journal databases mainly focus on clinical studies, far less on specific health services studies. The MeSH terms seem not always adequate to pinpoint particular organizational or policy issues. As a result, very little information can be obtained about the organization and health services models in the selected countries. It would be of no added value to deploy “selection of evidence” tables, because the selections steps (title and abstracts) already showed that a “circumstantial” approach would be needed. All the details of this approach can be found in the Appendix to chapter 8. For the pathology groups, some information was found resulting from a search in the medical peer reviewed databases. Again, the majority of the articles focuses on treatment and care, not organisational or policy issues. One exception to be quoted, is Germany for which more (local language) articles could be found. An additional search in the CIRRIE-database (Center for International Rehabilitation Research Information and Exchange) gave similar results, without much added value for our particular research questions. 8.2.4 Other information sources Factual information had to be gathered based on informal contacts within the sector, as most information in peer reviewed journals is dealing with clinical issues. Due to the lack of relevant (descriptive) information on organisational models in the peer reviewed journals, this part of the study is heavily relying on work prepared by WHO-health systems observatory (in particular the HIT-reports), a particular issue of the “journal of health economics” on the health benefits basket in different countries, on reports from professional organizations and on public information from administrative authorities. The information gathered draws also to a large extent on informal and personal communications with people (research institutes, administrators) from the countries studied.
KCE reports 57 Musculoskeletal & Neurological Rehabilitation 153 8.3 THE NETHERLANDS 8.3.1 Health care organisation in general The Dutch health care system is characterized by some fundamental policy changes since the end of the 1980’s 141 . In general terms, and due to problems both of serving the population and of financing (cost containment), the system is trying to make the shift towards a more flexible, demand oriented and market driven model. Policy makers are less imposing the particular organization regimes, but are creating the frameworks of a welfare state in which providers and the public is offered more flexibility in using and providing health care. The system reform is often identified as a movement from a “public regulated system” towards a “regulated market model”. The recent shift towards “market oriented models” implies a shift of the steering power from the public to the private sector. The health care system changes are built on the assumption that more market forces will enable a more efficient and effective health care system, and especially a more flexible system that is able to handle the fast changing heath care needs and demands of the public. The health care system changes aim at improving the quality whilst also controlling public expenditure. 8.3.2 Health insurance Since the mid 1990’ two major insurance regimes affected the use and right to medical and social care: de ziekenfondswet (ZFW) en de Algemene Wet Bijzondere Ziektekosten (AWBZ) The ZFW and AWBZ provided for benefits in kinds, while the AWBZ also provides for cash benefits. • Treatment and services available under ZFW are (in general terms): medical and surgical treatment (including limited number of sessions for physiotherapy and speech therapy); obstretic care, dental care, pharmaceuticals, non psychiatric hospital admissions; aids and appliances; transport, maternity care and care in an audiology centre; costs for genetic testing, haemodialysis, services for patients with chronic recurring respiratory problems, rehabilitation, and services of a thrombosis prevention unit. • The underlying principle of AWBZ is that people should continue to live in their homes as long as possible, whether they receive care at home or in an institution: For the AWBZ seven distinct functions are defined: domestic help, personal care, nursing care, supportive guidance (helping in the organization of daily life), activating guidance, treatment, and accommodation Since January 2006 a new, mandatory national health system, imposes individuals to purchase private health insurance. A standardized basic coverage (Basisverzekering) is guaranteed for all citizens by means of the Ziekte-Verzekerings-Wet (health care insurance law) (ZVW): • Medical care, including hospitalization (up to 365 days) and specialists; • Dental care for children (under age 18); • Specialist dental care and dentures for adults; • Pharmaceuticals; • Maternity and postnatal care for up to ten days after childbirth; • Ambulance and transportation costs; and • Some medical and paramedical rehabilitation services.
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Dépôt légal : D/2007/10.273/19
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