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8.4. Appenddices:
models in five other co ountries: detailss
by country
8.4.1. After-hhours
care in Thhe
Netherlands
Items
Expert(s)
Data sources
Characteristics off
the
health system with
relevance to after-
hours services
Situation before
reform
Drivers for systemm
reform on after-hoours
care
Affter-Hours
Primaary
Care
Results
Linda Huiberss
(L.Huibers@iq.umcn n.nl)
IQ healthcaree
Universiteit NNijmegen
National and international publications
and websites on tthe
topic of after-hourss
care in the Netherlannds
(see annex)
Population off
16,4 million (2008)
Health care inn
the Netherlands is re egulated publicly and delivered privately, in a system of “managed
competition.”
Health care sspending
per capita pe er year: 4.479 EUR
All residents are required to purcha ase a standard health insurance package froom
a private insurer, ccovering
primary and hhospital
care and mosst
of the available
pharmaceuticcals.
Wage-relatedd
contributions are poo oled in a central fund aand
redistributed to the
insurers according tto
a sophisticated risk-adjustment
formula. Insurers
also charge thheir
own communnity-rated
premiums.
The governmment
determines the co overage provided and the income-linked conntribution
that patientss
must make.
Most people purchase complementary
private insurancee
for services not coveered
by the standard benefit
package.
Long-term caare
is covered through a separate statutory iinsurance
program.
GPs operate mostly in duo or group
practices (80%).
GPs are gateekeepers
for their listed d patients (approximaately
2300 / GP) (gatekkeeping
to most other primary health care professionals
and to seecondary
care/hospital
care). Physiootherapist
can be cons sulted by patients withoout
referral of a GP.
Percentage oof
referrals by GPs to specialists s (secondaryy
care or other primaryy
health care providerss):
4%
GPs are geneerally
self-employed and a paid through both fixed capitation rates ffor
the listed patients and fee-for-service.
There are 8783
practising GPs (20 008).
A full-time woorking
GP has a practi ice list of approximately
2300 patients.
Before 2000 GPs provided care in small-call rotations (generally
5 to 10 GPs) in which they performmed
after-hours care too
each other’s patientss
during weekends and
evenings andd
nights on weekdays.
This small-sccale
handling included 10,000 to 20,000 patients
with distances up
to 5 km.
Patients had access via the GPs own
telephone numberr.
Before the reeform
GPs received ap pproximately €4,538 per
year, excluding the fee-for-service paymeents
of privately insureed
patients.
Main drivers from the GP perspective:
The initiative or reorganising after- hours care has come mainly from the professsion
(GPs) itself, disssatisfied
with the organization
of former rotaation
groups in after-
hours primaryy
care. The Netherlands
has followed the British
and Danish exammples
on the organizaation
of after-hours carre.
The dissatisfaaction
was mainly due e to:
A high perceiived
workload (on ave erage 19 hours a weekk
on top of a 48 hours workweek)
A lack of separation
between work and private life.
Non-urgent innterventions
during aft ter-hours periods
Growing demmand
for services by th he public and aggressive
behaviour of patiennts
Low financial renumeration
Lack of material
and logistic suppo ort
Main drivers from the government perspective:
The impedingg
shortage of GPs in the
future and safety isssues
were the main ddrivers
Accessibility and quality/safety of after-hours a primary carre,
particularly in urgent
situations
Costs
KCE Reportss
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