The five trends in care and welfare that you need to know
Value-driven care is, simply put, achieving more health for less or the same money. And this is necessary to meet the challenges of the future.
We are faced with a rising and changing demand for care and a huge increase in the cost of care. This is because we are getting older and not always living healthier lives. For example, we are seeing an increase in diseases of affluence, such as obesity and diabetes. At the same time, patients are given an increasingly active role in making independent decisions about their treatment and desired outcomes. At the same time, healthcare costs are increasing due to innovations and new treatment options.
To ensure a sustainable future for healthcare, it is a major challenge to overcome the current fragmentation of healthcare. We must learn to work together across the boundaries of healthcare organizations and domains. However, this is easier said than done, which is why successful collaborations often fail to materialize and why there is a strong temptation to give up and carry on as before. Or to not even start. In this blog we will show you why these are not options. We do this by looking at the most important trends for the coming decades within healthcare. After reading this blog, it will be clear that we will have to take the path of value-driven care to maintain a healthy, affordable and future-proof healthcare system.
Demand risk alarm
On the demand side there are some alarming developments, such as the continuing aging of the population, the increase in the number of chronic, multimorbidity patients and the rise in the cost of care.
Everyone knows that our society is aging. But how serious is it really? The number of elderly people will continue to grow in the coming decades. In 2000 there were 2.15 million people aged 65 and over, in 2030 there will be 4.25 million (figure 1). This increase has two important consequences. First, it will lead to an increase in the demand for care. For although we are living longer in good health, we will almost always develop one or more chronic conditions at an advanced age, partly because advances in medical technology mean that conditions that are currently fatal will become chronic. Secondly, the aging of the population is causing a shift in the ratio of working to non-working people, which in turn leads to capacity problems in the labor market, especially in the care sector. In the future there will not be enough hands at the bedside.
Figure 1: Aging population
In 2011 the results of a study into the prevalence of multimorbidity in general practices were published (VanOostromet al, NTvG, 2011). Almost 13% of the total population and 37% of the over-55s had two or more chronic diseases. Almost 13% of the total population and 37% of the over-55s had two or more chronic diseases.
Figure 2: Multimorbidity in the Netherlands
Due to the ageing population and the unhealthy lifestyle of many, a further increase in chronic diseases and multimorbidity is to be expected. More recent figures from the National Institute of Public Health and the Environment (RIVM) support this. In 2016, 8.8 million Dutch people had one or more chronic diseases, or 52% of the population.Among people aged 75 and over, about 90% had one or more chronic diseases.This will put a heavy strain on the demand for more and more complex care.
#3 Healthcare costs
Since 1972, health care expenditures have risen continuously from 8% to 13% of the gross domestic product (GDP). Calculations by the National Institute for Public Health and the Environment (RIVM) show that health care expenditures will continue to rise sharply in the coming decades. This is due to the ageing population and the increase in the consumption of care due to better and more expensive care.In 2040 health care expenditure in the Netherlands is expected to be between 6% and 18% higher than it is now. Whereas health care costs are currently more than €5,000 per person per year, by 2040 they will have risen to €9,600 (assuming current price levels). This explosive growth is inevitable if healthcare costs continue to grow at the current rate and no further radical measures are taken.
The rise in healthcare costs will have consequences for healthcare premiums and personal contributions. At present, the majority of healthcare costs are collectively organised and financed. An average family pays almost a quarter of its income in healthcare premiums. By 2040, this could rise to between 30% and 45% of income (CPB Policy Brief, 2011).
Care offer risk alarm
The major risk alarm in terms of care delivery is waste. There are different forms of waste. In the US, the level of waste has been studied, leading to shocking insights. For example, it was found that on average 1/3 of healthcare costs per person are wasted unnecessarily; almost $3,000 per person per year. The Ministry of Health, Welfare and Sport recommended in 2014 that this should also be mapped for the Netherlands based on the waste indicators of Schwarts et al (2014). That this is necessary is also shown in an article by Miller et al (Bloomberg, 2018). They made an international ranking of countries with more than 5 million inhabitants, an average life expectancy of 70+, and more than $5,000 of healthcare spending per capita annually. Of the 56 countries, the Netherlands comes in 28th place. The problem is that there is often a lack of data to map wastage in the Netherlands, although indicators such as those used by Schwartslang are available for the Dutch situation.
Figure 3: Wastage in care
#1 Unnecessary care
Compared toother countries, the Netherlands scores high on the number of doctor’s visits, bypass surgery and dotter treatments. It is not inconceivable that this is the result of unnecessary care. Instead of taking a holistic view of what needs to be done for a patient, each care provider does its own thing without coordinating with others.
The administrative burden and the mistakes that are made as a result lead to unnecessary costs. In the Netherlands, unnecessary administrative costs represent 4% of the total budget.
#3 Fragmented care delivery
Everyone works on their own little island and data and results are not shared. Among other things, there is a lack of joint responsibility and joint data management. Care is fragmented, which leads to poor coordination and inefficiency.
#4 Price Inflation
The autonomous price increases in the market are also reflected in healthcare. Everything is getting more expensive. These price increases do not automatically lead to better healthcare outcomes for patients.
This includes all kinds of claim fraud. Wastage due to fraud in the healthcare sector is a growing problem in Europe and poses a serious threat to the healthcare system(Mikkers et al,2017).
#6 Failing prevention policy
Insufficient attention to preventive action leads to unnecessary medical intervention. Simply put: prevention is better and cheaper than cure. But in practice, prevention policy is still underdeveloped, also in the Netherlands.
Op towards a new healthcare landscape
No one can deny that the above story gives cause for concern and that we cannot sit back. A new care landscape is needed. We can distinguish five trends (see Figure 4) that will help us to bridge the widening gap between supply and demand. We will explain them below.
Figure 4: Trends in care and welfare
For a number of years now, the trend has been to demarcate the welfare state. We are increasingly transferring government responsibilities to organisations and citizens. Instead of ‘the state takes care of you’, there is a trend towards market and regionalisation. The idea is that this will bring care closer to the patient. You can see this in curative care, but also in the role of the health insurer, for example. This is done under the guise – whether or not that is true remains to be seen – that the government regulates matters less efficiently than the market.
There is a lot of growth in the consumerism of healthcare, i.e. in the provision of healthcare as a product or service. More and more people are choosing to undergo certain procedures in private clinics at home or abroad. The consumer is therefore gaining more power. As a consumer you choose your provider on the basis of price and quality, but they must be transparent. This leaves much to be desired in the Netherlands.
There is still a lot of room for improvement in terms of digitalisation, although there are already many initiatives in this area. For example, we see a huge increase in the number of apps to make healthcare more efficient and accessible. This is a positive development, except that only a few have demonstrable added value. There is also much room for improvement in the broad accessibility of data, such as through the EEPD. This is essential to be able to offer regionally coordinated care and to be prepared for future trends in the demand for care. If you use digitisation properly, you will soon see a return on investment. This could therefore be an important weapon in the fight against future problems. In addition, it can strengthen the position of the consumer, as quality, costs and performance become increasingly transparent.
#4 From volume to value
There is a clear trend from volume-driven to value-driven care. The rise of Value-basedHealthcare(VBHC)andTripleAimareclear examples of this. In both models, care outcomes play a central role. They determine the value of care and are the starting point of care provision. However, a number of preconditions have to be met for the sea to be effective. For example, regional cooperation across the entire chain of prevention, care and welfare is a prerequisite, and funding must be organised differently. Instead of budget financing, chain financing is needed. The lack of transparency is also a problem here. To make value-driven care a success, care results must become more transparent.
#5 Wellbeing and health management
In this concept, health is no longer seen as the absence or presence of disease, but as the ability of people to cope with (changing) physical, emotional and social life challenges and to exercise as much control as possible. Although this concept has come in for a lot of criticism, a big plus is that its focus is on keeping people healthy. By investing in this, we can reduce the problems we are heading for, because – as already stated – prevention is better than cure. Better for the individual, but also better for the wallet. General practitioners must play an important role in this transition, but employers can also contribute.
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