The FWG Foundation regularly reports on trends in the healthcare sector. Ten years after it published its first report, FWG asked ten experts who were there at the very beginning to reflect on their statements at that time. One thing Annemieke Bambach, Director of Het Gastenhuis, noted was that market forces have not played enough of a role in elderly care.
‘Taking healthcare back to the drawing board’, ‘Healthcare deregulates’ and ‘Healthcare: unequal for everyone’: these FWG reports, which are well known in the care world, have highlighted healthcare sector developments in the Netherlands in recent years. FWG has now released a collection in which the organisation asked ten experts to reflect on those developments: which predictions have come true, and which have failed to materialise? Which changes were rapid, and what has progressed more slowly than expected?
One development that has clearly fallen short is the use of comparative, high-quality information by care consumers; that is the position of Diana Delnoij, a lecturer at Erasmus School of Health Policy & Management (ESHPM) who is affiliated with the Dutch National Health Care Institute (Zorginstituut Nederland). Ten years ago, Delnoij expected the development of performance indicators to stimulate care providers to work on improving quality, as care consumers would increasingly ‘vote with their feet’. She now realises that there has only been very limited progress toward that prediction: according to research by Nivel, last year only 17% of care consumers searched for information about care providers to find out which provided the best care, to learn about people’s experiences and to make an informed decision.
On top of that, there has also been an unintended side effect: “In the past ten years, we have had to face the fact that the registration and publication of quality data by care providers is viewed not simply as a source of input to help improve quality, but mainly as a heavy administrative burden,” says Delnoij.
True innovation has failed to materialise
Other developments in healthcare have also failed to progress at the pace that experts expected. Bettine Pluut, a strategic adviser and action researcher at the ESHPM, furnishes the example of the development of remote care. The idea was to coach care consumers in how to interpret the health information available online and the results of tests conducted remotely, so that these consumers would be less likely to approach care providers. However, efforts to scale up this programme encountered a whole range of obstacles, such as a lack of sound action research, insufficient knowledge sharing and negative financial incentives. According to Pluut, this has prevented true innovation from being implemented in the healthcare sector, and many organisations use digital applications without redesigning their care processes in a meaningful way.
There was one development for which expectations were very high: the introduction of market forces in the healthcare sector. Annemieke Bambach, Director of Het Gastenhuis – an NPM Capital portfolio company – shared those high hopes ten years ago, but now sees that those market forces have not played enough of a role in elderly care. As she explains, “Five years ago, the government opted for mass closures of old people’s homes. The magic word was ‘home care’. But the growing number of people who can no longer manage at home – and their families – are experiencing a painful reality that has resulted in isolation, depression, too much work for informal carers and a shift to expensive hospital admissions. The current model is untenable, both socially and in terms of cost.”
Bambach believes that the problems in elderly care demand smart concepts that can be rolled out rapidly and implemented more efficiently than the current healthcare system. “Those concepts are already available,” she says, “but there’s a lack of collaboration and political will. There’s still a stigma attached to entrepreneurship in care, which means that serious entrepreneurs have to walk on eggshells, even though they are the ones who really understand how to design an efficient and future-proof model.”
On the other hand, the FWG publication also showcases some healthcare developments that have achieved momentum unexpectedly rapidly. One aspect that stands out to Nicolette Warmenhoven, strategic adviser at the National Institute for Public Health and the Environment (RIVM), is the growing focus on preventative measures. “Ten years ago, ‘prevention’ was still a loaded term,” she explains, “but now there’s a National Prevention Agreement in place, and municipalities are working to adapt it to their local situation. Things are heading in the right direction.”
Finally, there has also been unexpectedly significant progress in terms of medical technology. “Operating rooms are not yet free from wires and cables, but developments are now coming thick and fast,” says Karianne Lindenhovius, CEO of ArthroSave. Lindenhovius has great hopes for the development of AI and machine learning. “We sometimes find it worrying that systems can be self-learning, but I think that a lot of human brainpower in the healthcare sector will be taken over by machines in the next few years.”