The formation of the Integral Care Agreement is imminent. The new ministers are renewing themselves by tackling it integrated across the various sectors this time. With a number of challenges facing healthcare, the call for an agreement that works is higher than ever before. The big question, therefore, is: what elements should be included in that agreement? David Ikkersheim and Luuk Versluis from KPMG Health make a cross.
Share scarcity: agreements on how many employees work in the health care system
We have moved from an economy of ‘abundance’ to an economy of scarcity, even though there are many social tasks – also outside the health sector. Where ‘previously’ primarily economics was the bottleneck, labor is now (also) to a significant extent. Figures from RIVM and CPB show that 1 in 6 people in 2022 will work in the health care system, and that if the policy remains unchanged, this will increase to 1 in 4 in 2040. This is increasingly unsustainable, among other things in light of of other sectors where one needs a lot of staff.
We have seen for years that finances are dominant in the care agreement. The latest letter from NFU, NVZ and FMS to VWS also seems to be based on economics as the dominant governing mechanism. Of course, the economy ‘controls’ the deployment of staff. But now that the staffing factor has overtaken the economy as the biggest bottleneck, we think it would be a good idea to draw up a Nursing Staff Framework (PKZ). PKZ must be prepared as a supplement to the Health Budget Framework (BKZ) and describes how many man-years the health sector will deliver in the coming years. This determines how we can best deploy the available staff to achieve the maximum health benefits, in relation to all other societal challenges. The exact observance of this is still a puzzle, but for the Netherlands it is of great importance that we no longer share the “economic cake”, but the “personal cake”. And for the healthcare system, it is also of the utmost importance that it happens as quickly as possible in a sustainable way: if we do not do that, the slice of the cake for the healthcare system will quickly become smaller.
Setting clear (preliminary) goals and an administrative PDCA cycle is important for the success of the integrated care agreement. Concrete goals sound good, but in practice they are not so easy with agreements at the macro level. Nevertheless, here are a few examples of possible clear goals in addition to the staff frameworks already mentioned:
- Concrete goals for health: BMI to a certain percentage, concrete goals for exercise, reduction of smoking to zero, vaccination coverage, etc .;
- Concrete goals for concentration and distribution of care, for example, concentration of congenital heart care implemented by 2024;
- Concrete goals within the regional cooperation, where new care models have been implemented. For example, targets can be set for the percentage of digital care and transfer of care to the home situation.
The contours of the health landscape of the future are known, but it is not always easy to realize them. Time and time again, however, we see that the health area speaks positively about the goals, but that the realization lags behind. The impossible is regularly asked of healthcare providers. We saw this recently in the concentration of congenital heart care, where the field of care itself is not able to reach out. Something similar also applies when you move the hospital care to the home situation. In both cases, a healthcare provider is asked to stop doing something, whereby the compensation for the fixed costs that continue to run is insufficient. All of this requires more guidance from VWS, health insurance companies and possibly parties such as the National Health Care Institute and the Dutch health authority and guidance than has been the case in recent years.
The proposed Care Personnel Framework, the specific goals and the direction of implementation reinforce each other. The right deployment of staff in the right place speeds up the necessary reorganization of the healthcare system and increases the chance that the concrete goals will be achieved.
Preparation and direction for a higher pandemic preparedness
The list of experiences from the pandemic has since been detailed in a number of reports. A selection of these lessons shows that a great many optimizations are possible, but that only a combination of actions really makes the difference. Unfortunately, there are none silver ball, neither here nor abroad. For example, it is a good idea to proactively encourage high-risk groups of GPs to get vaccinations on time, and it is also wise to have hospital treatment performed at home via telemonitoring, which is far from happening everywhere.
So far, a selection from our wish list – because we still forget the right care in the right place, disruptive care and much more. What does your wish list look like?
David Ikkersheim and Luuk Versluis are partners at KPMG Health