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Chapter 8 | The impact of the crisis on the health system and health in the Netherlands
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between different health care professions, leading to less dependency on highly
specialized care and to lower costs for care. However, delegation of tasks has
appeared to be difficult in practice as it requires the adaptation of hierarchies,
legal medical responsibilities, competencies and professional domains.
4.5 Transparency and accountability
Increased focus on improving efficiency and prevention of fraud has likely
contributed to increasing attention being paid to the transparency of the health
care system. Other measures may have also contributed (indirectly) to increasing
transparency, although it has to be noted that they were not driven by the
economic crisis. Examples are the application of information and communication
technology, innovations to streamline health care processes and the (re)design of
health care organizations to increase their flexibility, efficiency and patient service
(e.g. enabling e-mail consultations). In the area of specialized care, the DBC
financing system, which had been in place since 2005, was redesigned in 2012 to
increase its transparency, with the number of DBCs reduced from over 30 000
to about 3000. This new project was named “DBCs on the way to transparency”
(DBCs Op weg naar Transparantie). Another example of increasing transparency
in the system is the increasing publication of comparative information on health
care providers on the Internet, for example through web sites such as the National
Health Care Institute's kiesBeter (www.kiesbeter.nl) and Care Map Netherlands
(Zorgkaart Nederland; www.zorgkaartnederland.nl), enabling patients to choose
providers and publish their experiences. More recently, in January 2014, the
organization that governs the DBC system (DBC-Onderhoud) decided to
publish a range of prices for specialized care to inform citizens and enable them
to compare providers (including hospitals).
4.6 Impact on health
The health status of the Dutch population remains at a high level. In general,
it seems safe to state that it has not yet been affected by the economic crisis.
However, some negative signs have been reported recently.
In 2013, the Dutch Financial Times (Het Financieele Dagblad) reported that
doctors and health organizations saw an increase in the number of employees
who visited their GP or occupational physician because of mental health
problems resulting from fear of job loss (Cats & Olsthoorn, 2013). In the same
year, the Netherlands Centre for Occupational Diseases (Nederlands Centrum
voor Beroepsziekten) reported an increase in the number of “burnout” cases
and depression linked to job loss and lowering housing prices (Netherlands
Centre for Occupational Diseases, 2014). The Trimbos Institute has started
research on the relationship between the economic crisis, depression and suicide
(Cats & Olsthoorn, 2013), but no data are available as yet.