Joining forces within the healthcare system
will be of benefit to us all
The future of our healthcare system is a hot topic: in the cabinet formation, on the news and at the lunch table. This past June 8th, we at Motion5 organized an event on leadership in the healthcare at the Bartholomeus Gasthuis in Utrecht. In preparation for this event, I interviewed healthcare professionals, strategy consultants and MedTech professionals about the future of the healthcare system in the Netherlands. In this article, they share their views and explain how they strive to improve on Dutch healthcare and make it more affordable.
The current discourse on the healthcare system is dominated by points of criticism. The Dutch are intolerant towards inefficiency and wasting resources. These are valid points – but are we at risk of being too pessimistic? How is the Dutch healthcare system now really doing?
The Dutch healthcare system is top notch
Our healthcare system continues to shine at the top of international lists. Early this year, renowned London research firm Legatum Institute published their annual Prosperity Index. The Netherlands comes in 5th out of 149 participating countries on the sub-index Health. The Euro Health Consumer Index 2016 even declared our healthcare system to be the best in Europe.
Robert Steemers advises hospitals, mental healthcare institutions, health insurance companies and municipalities on the financing of healthcare, and he is equally enthusiastic: “The quality of Dutch healthcare is high and its accessibility is generally good. Managing costs is always going to be a challenge. But the fact remains that the increase in costs has declined in recent years. The role that health insurance companies have played, contributed to this fact. Now it is a matter of removing production stimuli from the system, so that healthcare professionals can continue to focus on quality and no unnecessary costs are made. “
“The high quality and accessibility of our healthcare system is indeed something to be proud of,” according to Irmgard Krooneman of the University Medical Center Groningen (UMCG). “At the same time, we cannot close our eyes to the fact that financing healthcare poses a problem for a particular group of people. Another point of concern is the power that health insurance companies hold.” In the Heyendael Manifesto for Better and Affordable Care of April this year, twelve key opinion leaders within the Dutch healthcare system advocate a framework agreement with a strong substantive focus. “Within the current system there are still many ambitions to be realized, and a system change will cost a lot of time and energy that is better spent on objectives concerning the content.”
Ambition equals innovation
To me, the word ‘innovation’ triggers topics like e-Health, startups and new technologies. I talked to Koen Harms, co-founder of the startup Cair. On their website, clients were able to select their caregivers themselves from a pool of screened independent nurses. After its successful launch, the startup unfortunately failed to overcome its initial obstacles. Investors wanted certainty about obtaining care contracts and insurers would only grant their approval if certain investments had been made. Is this kind of catch-22 typical of the innovation climate of the Netherlands? “The preconditions for promising startups are not yet ideal. Renewing the current contracting and funding formats could lead to a boost in innovation.”
“The role that hospitals play is changing,” says Koen. “Hospitals are going to become hubs where different kinds of healthcare come together. Rather than huge buildings, hospitals will become places for undergoing treatments and monitoring.” In addition, he expects developments such as blockchains to have a big impact. “In 20 years, information and funding systems will no longer be controlled by certain parties, but through a network. Patients will be able to really make their own choices and buy their own care. This will mean a lot for the organization of healthcare.”
Kees Smaling of Siemens Healthineers agrees on the huge opportunities that developments on e-Health and big data can offer. “As in other markets, these kinds of innovations are driven by the masses. The breakthrough will come when consumers will start seeing the benefits of innovation and embrace the possibilities en masse. Time and demographics play an important part in winning greater acceptance. The hurdles we are still facing when it comes to sharing and handling data are not only technological, but rather psychological in nature. Care policies are still largely determined by healthy people. This creates a gap between policy and reality.”
But who is going to pay for all this?
Innovation, higher quality of care and patient centricity: it all sounds great. And expensive. “Quality innovations aim to create a more effective healthcare system, so that less care will be required,” says Robert Steemers. “At Strategy&, we advise organizations on the transition to a different interpretation of care. We take out the production stimuli and let the doctors decide what is the appropriate care for the patient. The result: less unnecessary treatments, a higher quality of care and therefore lower costs. This clears the way to invest more in innovation.”
Robert is convinced that a lot of money can be saved by investing in the front-end of the healthcare industry. “Think about placing experienced specialists on emergency care instead of physician assistant. Experience shows that this avoids unnecessary diagnostics and hospitalization. Or placing mental healthcare knowledge in a neighborhood team, which leads to fewer escalations. The current financial system does not automatically facilitate these kind of developments. Together with healthcare providers and insurance companies, we are bringing about change by creating a playing field where medical professionals are given the elbow room to focus on creating better and smarter healthcare, rather than having to worry about production and cost control. This way, quality and saving money go hand in hand.”
Specialization within complex care
For the last two years, I’ve lived in Houston, Texas, which is home to the largest medical center in the world, the Medical District. Every year, 180,000 surgeries are performed here. That’s one surgery every 3 minutes. Indeed, everything is bigger in Texas. In addition to the size of the hospitals, what struck me most was the high degree of specialization. Take for example the Texas Children’s Hospital, a children’s hospital with over 600 beds which also happens to be a frontrunner in patient care, education and research. The adjacent MD Anderson Cancer Center is the largest hospital specializing in the treatment of cancer in the world.
Skyline of the Texas Medical Center by David Daniel Turner
Will Dutch hospitals start to specialize more as well?
“When it comes to specialization, America is certainly in the lead,” says Irmgard Krooneman. “As an academic hospital, we are specializing more and more. That is why were are investing almost 150 million euros in a new OR complex. Our current operating rooms meet all requirements, but are too small for the increasing amount of equipment. Flexibility in the OR is also very important. As a academic center, we want our specialists to treat their patients in the most effective and modern way possible.”
Koen Harms views specialization as an important trend too. “I think we are headed for a network of regional hospitals for less complex care. For complex care, patients will be referred to specialized centers and academic medical centers. The need for specialization is also a direct effect of the increasing degree of complexity in medicine.”
In line with the specialization trend is the progressive collaboration between Siemens Healthineers with the Admiral de Ruyter Hospital (ADRZ) in Zeeland. Siemens is the builder and owner of the OR complex at the Goes location and rents out the operating rooms to the ADRZ. If the collaboration proves to be a success, we’ll be seeing this form of forward integration a lot more often in the future. “It makes perfect sense,” says Kees Smaling. “We as engineers are specialized in building such a facility. This way, the hospital can focus on its main objective: providing the best possible medical care. Smart collaborations lead to a healthcare system that is more efficient, more economical and of better quality. Our cooperation with the ADRZ is an example of that.”
Collaborate for the patient
In 2012, orthopedic company Biomet (now ZimmerBiomet) treated the first patient in the Netherlands according to the Rapid Recovery protocol for hip and knee replacement. By combining medical optimization with organizational reforms – such as a more efficient collaboration between the various disciplines – patients were faster to regain their mobility after their surgery.
According to Koen Harms, we will be seeing these types of partnerships more and more. “Technology partners will not only supply the product, but also the process around it. In the end, we will assess organizations on the final product: the quality of life of the patient. A prerequisite for successful cooperation is that governance around the patient’s data is well-organized. Partners need to be even more involved in the primary process – providing good medical care – and focus less on their roles as salespeople.” Irmgard Krooneman agrees. “MedTech and Pharma companies are co-responsible for continuously improving healthcare for individual patients. Collaborations must result in a win-win situation for the hospital and the commercial partner. And most importantly, for the patient.”
Want to know more?
On March 8th, 2018, we will continue the conversation on how joining forces within the healthcare system will be of benefit to us all. Click on the button below for more information.