Organisatie en financiering van preventie in het zorgstelsel: wat kunnen we leren van het buitenland?

Samenvatting

Preventieve maatregelen voor groepen met een verhoogd gezondheidsrisico, zoals kinderen met overgewicht en eenzame ouderen, komen in Nederland soms moeizaam van de grond. De partijen die betrokken zijn bij de ontwikkeling en uitvoering van deze maatregelen, zoals gemeenten, zorgverzekeraars, zorgverleners en GGD’en ervaren verschillende knelpunten. Zo is niet altijd duidelijk wie waarvoor verantwoordelijk is of hoe preventieve interventies structureel kunnen worden gefinancierd. De minister van VWS heeft eind 2014 toegezegd onderzoek te doen naar de knelpunten en verbeterpunten voor preventie en daarbij ook te kijken naar het buitenland. Tegen deze achtergrond heeft het RIVM in 2015 de organisatie en financiering van preventie in het buitenland bestudeerd, op basis van semigestructureerde interviews met experts uit tien landen en internationale literatuur over de betreffende tien zorgstelsels. Uit het onderzoek blijkt dat de in Nederland ervaren knelpunten veelal ook in het buitenland aan de orde zijn. Tegelijkertijd biedt het buitenland voorbeelden van mogelijke oplossingen die eraan kunnen bijdragen om de in Nederland ervaren knelpunten op te lossen.

Abstract

The financing and organisation of prevention within the health system: what can we learn from abroad?

In the Netherlands, actors involved in preventive services targeted at people with health risks, such as overweight children or lonely elderly, are confronted with several obstacles to the development and implementation of preventive interventions. For example, it is not always clear to municipalities, health insurers, public health services and health care providers who is responsible for what. Furthermore, it is unclear how to finance these interventions in a structural manner. In 2014, the Dutch Minister of Health decided to investigate the obstacles and possible solutions to embedding prevention into the Dutch health system, including a study of prevention policies in other countries. Against this backdrop, the National Institute for Public Health and the Environment (RIVM) investigated the financing and organisation of prevention in ten high-income countries, based on interviews with foreign experts and international literature. The study shows that several foreign countries face the same issues, even though they often organise and finance their health services differently. At the same time, the Netherlands may learn from the examples of (policy) measures taken in other countries. For example, some countries have tried to more clearly delineate the responsibilities of different actors within their laws. Also, health (promotion) funds have been established to realize structural financing for prevention. Another example is the development of a national monitoring system that can be used to monitor the extent to which local authorities offer preventive interventions and activities. At this stage, it is unclear to what extent these measures will effectively solve the problems experienced in the Netherlands. Nevertheless, they are related to current policy discussions and therefore, deserve close attention. One important example is the developments regarding joint commissioning in England which may provide lessons for Dutch municipalities and health insurers trying to cooperate at the local level. Further research is needed to get a more comprehensive understanding of the advantages and disadvantages, and the effectiveness of the measures taken in other countries. In addition, the recently proposed measures by the Ministry of Health will be evaluated in the coming years. These investigations will show whether further measures are needed in order to realise a better organisation and implementation of preventive services.