By | Published On: 20 april 2021| Views: 103|


In recent years, there have been concerns about disease management programs in the Netherlands. The bundled payment rate that general practitioners receive from the health care insurance on top of their regular rate is in jeopardy. There is also a substantive discussion going on; is disease management, as we make use of it in the Netherlands, real disease management? And does the model fit into the current practice in which we keep seeing an increase in people with multimorbidity and a complex demand for care?

Not whole disease management but half disease management

In disease management, the various stages of care are aligned in such a way that a coherent offer is created, based on the symptoms and needs of the patient. The concept has been adapted from the US to the Netherlands in the 1980s-1990s, where it has been implemented in primary care for patients with chronic diseases, such as type 2 diabetes, cardiovascular problems and COPD. Secondary hospital care, however, was not included in the bundled payment schemes. As a result, there is in fact no disease management in the Netherlands, but rather half disease management. Is this a problem? Yes, because we are not achieving the desired results in terms of quality improvement and cost savings. Where disease management is applied in the Netherlands, we see increasing costs and only minimal improvements on quality indicators. In contrast, clear positive effects have been demonstrated in countries such as the United States, England and Germany. There is a simple explanation for this: in these countries, health care insurers and/or governments include both primary and secondary care providers within their blended payment. As a result these care providers work together in a single organization network. These organization networks have joint quality frameworks and guidelines. This way, it works out fine.