Care Coordination for the Chronically Ill; Impact Assessment 2010

Multidisciplinary or integrated care for the chronically ill is making slow progress. In response to our audit the Minister of VWS had said in 2006 that he expected the coordination of care for the chronically ill to arise automatically from the introduction of regulated market forces. That was too optimistic. Integrated care is still available on only a limited scale. In 2009, people with a chronic ailment were not significantly more satisfied with the cooperation and coordination among the care providers they saw. The former minister had introduced a 'programmatic approach' to chronic ailments in 2008. In it, he clarified his vision of the required coordination and took action to promote it. The minister, however, did not specify a time horizon for his policy nor did he set measurable goals. The care sector itself is largely responsible for actual implementation of the 'programmatic approach' to chronic ailments. Implementation of the new care policy, however, is progressing more slowly than expected. Since the number of people in the Netherlands with one or more chronic ailments will increase sharply in the near future, the provision of integrated care is in danger of not keeping pace with the rise in demand. Only the treatment of diabetes has been relatively successful. In 2003, patients, care providers and academics developed a care standard for diabetes. It sets out what good diabetes care is and how it should be organised.

We again recommend that the minister make the policy less discretional. Integrated care for the chronically ill will not arise all by itself. We think the problem is so urgent that it requires a national plan. A multiyear plan would enable the minister not only to make performance agreements with the care sector but also to indicate how she will intervene if the agreements are not kept. In our opinion, greater patient involvement is a necessary condition for a demand-driven system. The minister should encourage the provision of patient experience to patient collectives. She could also use financial incentives to encourage smaller collectives to join forces. Care providers should receive more encouragement to develop care standards and to work together more closely when caring for the chronically ill. They should also have more incentive to buy care based on care standards. Finally, we call attention, as we had done in 2006, to the provision of information on the quality and cost effectiveness of integrated care.

The minister did not entirely agree with our comment that the implementation of the new policy was progressing more slowly than expected and that the provision of integrated care was in danger of not keeping pace with demand. She thought a lot had been achieved in a short period of time and that more time was needed – from both patients and care providers and care insurers – to embed the new way of working that the policy required. The minister will not adopt our recommendation for a national plan. She thinks such an approach would be too complex and therefore impracticable. The minister believes it will be more effective to draw up an administrative agenda with the parties involved so that agreements can be made on the implementation of the 'programmatic approach' to care for the chronically ill.