Towards a healthcare revolution: The power of regional collaboration

With its report, the RVS wants to give advice to the future cabinet on how the healthcare system, which came into force in 2006, can be adapted to 'provide space for people to do what is necessary'. The Council argues for cooperation instead of competition in procurement and provision of general practitioner care, district nursing, acute care and mental healthcare. In addition, she proposes to organise the care for elderly people living at home differently. This means that the WIz (Long-term Care Act) for this target group must be separated from the domains Wlz, Wmo and Zvw.

In doing so, the Council emphatically distances itself from the statement in the coalition agreement that the system is not up for discussion. "As far as we are concerned, the system is under discussion," chairman Jet Bussemaker indicated in the media.

System reform: yes or no

Claudia Brandenburg, healthcare partner at Financial Advisory Deloitte, calls it a logical report. "My first thought was that, based on developments in society, there are no unexpected things in it," she says. "But my second thought was immediately: does this stimulate the innovation we need now? And for what problem is this the solution?"

Her colleague Maurice Fransen, healthcare partner Deloitte, understands this caveat well. "No one can disagree with the main line of cooperation and learning from each other," he says. "I also see that in the fragmented healthcare landscape, the necessary steps in the field of technological innovation are difficult to take without a shift from competition to collaboration. But I doubt that a change in the system is the right solution to achieve that goal."

Brandenburg adds: "The question is indeed whether a change in the system is necessary to introduce the right incentives into the system. There is no guarantee that this will bring us closer to the goal, as there is no clear roadmap to maintaining accessible and affordable care." Both Deloitte partners therefore understand the reaction of (now outgoing) Minister Ernst Kuipers of the Ministry of Health, Welfare and Sport, who prefers cooperation and appropriate care on the basis of the Integral Care Agreement (IZA), rather than a radical system change.

Take steps now

Cooperation is not an end in itself, Brandenburg emphasises. "It is a prerequisite for realising a regional approach and the necessary ICT solutions." A change in the system is not a goal either, according to Brandenburg and Fransen. It would take up a lot of valuable time. It is important to take rapid steps towards more efficient and innovative patient care, in which healthcare workers and patients are supported as much as possible by technology and can be treated remotely.

"If you're going to change things that aren't focused on the goal, you're wasting a lot of energy," Fransen says. "It's better not to get distracted by that and focus on what can already bring us closer to the goal." He believes that the basic principles for cooperation are already in place in the IZA, with the aim of implementing labour-saving technology in the regions. "If we actively work on this, we can go a long way."

A good explanation of the changes is essential, Brandenburg adds. She illustrates this with an example: "If the prices of dressings are listed in dressing cabinets, nurses will use them more efficiently, which saves costs. But we now see that more and more patients are receiving care at home, patients who used to stay in care and nursing homes. Take eye dripping as an example. If home care has to do this, she can drip two patients per hour. In a nursing home or care home, it was possible to do the entire floor in an hour. The costs of this treatment at home are therefore many times higher and this price tag must be transparent for patients and healthcare workers. With a larger number of patients at home, this becomes unfeasible and alternatives must be developed. You can, but it needs to be explained to patients. It's about acceptance and behaviour of both patients and healthcare workers."

Making collaboration work

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Such things can also be done at home. The advantage of retail is that there is someone present to provide support in using the technology and can give advice. That can promote acceptance. "But of course, retail is only the first step," Fransen warns. "Ultimately, the entire chain needs to be scrutinised. It has to be a holistic approach. And of course, data availability is essential in this regard. We should focus on establishing a strong foundation for data accessibility rather than creating a separate system for each issue. Currently, we are seeing too many fragmented solutions."

The importance of the region

At the heart of it, Fransen and Brandenburg argue, is regional cooperation. "It is difficult to estimate the impact on existing organisations," says Brandenburg. "That does make administrators reluctant.

Yet it is inescapable, Fransen argues. "Look, for example, at the great potential of medical service centres in the region, where all patient signals are processed centrally. Functions can be added, such as making appointments online or contacting chatbots. But then the entire chain has to be adjusted. The right starting point for this is: how do citizens think and act and how can we make optimal use of nurses' scarce time?"

This can lead to different approaches in each region," Brandenburg adds. "For example, urban areas face different health issues compared to rural areas." Taking the citizen as a starting point, as Fransen argues, represents a significant shift from how healthcare is currently organised. "That's why we call it a transformation," Brandenburg concludes matter-of-factly. "Of course, some parties will experience disadvantages, but they will have to learn to accept them. It is clear to everyone that this transformation is necessary."

This article was previously published in ICT & Health magazine.