Achieving High Performance Quality in Primary Healthcare: The Dutch Example
Authors: Marjan J. Faber, Jako S. Burgers, Richard Grol and Gert P. Westert
Abstract: Good primary care can be described as first contact care, continuity over time, comprehensiveness, and coordination with other parts of the health system. The Netherlands is increasingly recognized as a best practice model of primary care. Methods: We used data from the Commonwealth Fund International Health Policy Surveys of 2006–2009 to describe the most relevant elements in the Dutch primary healthcare system. These studies were telephone surveys targeting random samples of three groups of respondents – citizens, chronically ill patients, and general practitioners (GPs) – asking their views and perceptions on a wide range of topics. Data from Dutch observational studies of general practices were used to complement the picture. Results: Dutch general practices are easily accessible during office hours as well as out-of-hours, guaranteeing reliable 24/7 access. There are no co-payments for care delivered in general practice. Most practices, privately owned, offer a wide range of services. Advanced practice nurses are involved in chronic care management. Increasingly, tasks are transferred from hospital specialists to GPs, supported by financial incentives. Regional collaborative care groups of GPs offer disease management programs (e.g. diabetes, COPD). Almost 100 percent of the practices use electronic medical records. Quality improvement in primary care includes evidence-based guidelines, performance indicators, and many innovative experiments. Discussion: Bottom-up and top-down activities contributed to a successful primary care system. Strong aspects are the 24 hour access to general practice, the advanced electronic medical record, and the quality assessment system predominantly driven by professionals. Lessons can be learned from the Netherlands and may be applicable to health policy experiments and health reforms in other countries.