Quelles solutions pour la garde en médecine générale? - KCE

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96 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 171
KCE Reports 1771 Items System reform (since Tendency towwards large scale cooperatives (40-250 GPss taking care of populaations ranging from 1000,000 to 500,000 inhabitants). 2000) and type of A total of 7.7000 GPs are registered d with a cooperative (tootal > 130). reform Number of actual 1 main modeel models used: Type of models Financer and financing system Characteristics off model most frequently used (General practitioner cooperatives) Affter-Hours Primaary Care General pracctitioner cooperatives (mostly ( used) coveringg 95% of the populatioon. Results Remark: Patients with a medical pr roblem during after-hoours times can choosee either to attend the GGP cooperative or the hospital emergency department. Contact wwith the GP coopeerative is preferred, bu ut patients cannot be ddenied access to the EED. However, they migght be advised to attend the GP cooperativee, particularly if this is located near the hospital. GPs are paidd per hour on call (65 Euros E per hour) There are no financial incentives fo or patients for any partticular behaviour (use of GP cooperative or emergency departmeent). Initiator: GPs. Number of GPs taking part in large e scale cooperatives: 98% of GPs ttake part in large scale e cooperatives. Number of coooperatives: Currently > 130 GP cooperatives. 98.2% 9 of the Dutch poopulation can reach a GP cooperative withinn 30 minutes by car. Population: 50 to 250 GPPs take care of populat tions ranging from 1000,000 to 500,000 inhabitants. 250 per 10000 citizens contact GP cooperatives. c (Annual) use of GP cooperative 250 patients per 1000 inhabitants. 6% of patientts is referred to accide ent and emergency departments. Health probleems (top-5): acute infe ections (26%), musculoo-skeletal problems. ( 12.8%), digestive probblems (10.1%), traumaa (6.8%) and respiratoory problems (4.8%). Distance: Distances upp to 30 km Indication: Intended for uurgent help requests that t cannot wait until the next day. Availability: Available daily from 5 p.m. to 8 a.m m. and the entire weekkend. Time frame foor answering to calls: Urgent calls hhave to be answered within w 30 seconds andd regular calls within 2 minutes. Time frame foor urgent and non-urgent visits: Average waitting time for non-urgen nt visits is 30 minutes and 90% of the patiennts get a visit within onne hour. Urgent visits: sometimes cooperation with ambulance seervice, in case of cardiiac arrest. Location: Most of the time situated near or within w a hospital, but haave not formally regulaated patient flow in conjunction with the hosspital or its emergencyy department. The trennd is to co-locatee the GP cooperative and the ED, often withh one entrance and deesk with a triage nursee. Patients with a medical problem du uring after-hours timess can choose either to attend the GP cooperrative or the hospital eemergency departmennt. They can also contaact 97
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KCE REPORTS 2011 171B QUELLLES SOOL
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Contrôle Direction Contact Comm mi
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COLOPHOON Titre : Auteurs : Experts
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KCE Reports 1771B PRÉFFACE Il y a
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KCE Reports 1771B Obstacles liéés
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KCE Reports 1771B SYNTTHÈSE Garde
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KCE Reports 1771B 1.3.2. Chargees d
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KCE Reports 1771B La plupart des é
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KCE Reports 1771B PROCESSUS PROCÉD
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KCE Reports 1771 SCIENTIFIC RREPOR
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KCE Reports 171 Affter-Hours Primaa
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KCE Reports 171 Affter-Hours Primaa
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KCE Reports 1771 38. Pickin DMM, O'
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