Dutch Healthcare Under Pressure

August 31, 2017

Pressure is piling up on the Dutch Healthcare system; more care, higher expectations, demanding and ageing patients are continuously adding strain. Overall, there are three main forces responsible for the gradual increase of pressure throughout the years; affordability, patients’ needs, and lack of innovation. The question on everyone’s mind is, for how long can we handle this increasing pressure and what can we do to relieve it Platform innovation should do the trick.


3 Causes for Pressure on the Dutch Healthcare system


1. Affordability


Healthcare costs are continuously increasing (figure 1).The CPB (Netherlands Bureau for Economic Policy Analysis) expects that healthcare costs will soon again grow faster than GDP, threatening both the quality and availability of the Dutch healthcare system.


Figure 1: Healthcare expenditure in Euros and % of GD2,3


2. Patient Needs


Healthcare consumers are increasingly demanding treatment and costs transparency. Tinformation age provides patients the means to become more involved in treatment. Due to perceived service models in more mature markets, patients are demanding higher quality of service experience from healthcare and insurance providers. The result is a growing demand for a patient journey that includes personalized care, shared decision making and ‘home unless’ (care centered around the patient home unless the hospital is required). This requires adaptation of processes and organizations to facilitate this new way of working.


3. Lack of Innovation


The current pay-for-service model slows down large scale innovation. Currently, healthcare providers receive compensation for the number of performed treatments (volume-based), instead of treatment results (outcome-based). This provides little incentive for deploying innovative solutions aiming to increase productivity, as these often decrease treatment volumes, subsequently reducing income.



How to relieve pressure?


The Value Based Healthcare (VBHC) model is widely regarded as a potent model for addressing many of the challenges the healthcare system faces these days. It starts and ends with ‘The patient knows best’, installing the patient centrally. Patient outcome becomes the major driver for payment, resulting in a shift from pay-for-service to pay-for-performance. Although widely regarded as one of the more potent solutions to current healthcare issues, there are still multiple challenges when it comes to implementing VBHC; Organization & Culture and Data & IT.


Organization & Culture


VBHC requires care, centered around Integrated Practice Units (IPUs) that focus on treatment of specific diseases, and bring together all necessary specialties. For example, seeing endocrinologists, podotherapists and dietary specialists in diabetic care. Additionally, implementation of VBHC requires a transparent culture. Caregivers must be encouraged to share data and information on outcomes which, together with patient experience, are used to identify and implement specific changes. As multiple IPUs emerge, patients are given the means to select hospitals based on outcome, benefiting both quality of healthcare and individual experience.


Data & IT


Availability and access to data and information is crucial in VBHC. Successful implementation depends on large volumes of findable, accessible, interoperable, and reusable (FAIR) data on patient needs, treatments and outcomes. Currently, this often proves challenging as data availability is generally poor, due to closed ICT-systems, rigid IT, and siloed data. Different (legacy) systems are difficult or costly to connect, making it expensive to combine and utilize data value. When data can be extracted, quality is often low due to inconsistent storage and/or its unstructured nature, making analysis difficult. Finally, VBHC requires more and different metrics for measuring treatment outcome, many of which currently don’t exist. For example, knee replacement operations are seldom lethal, as can be expected, however ‘time to return to work’ is rarely, if at all, registered.

Platforms are a connected infrastructure that enable service providers, payers and consumers to exchange data and information in a safe and secure manner. It’s a digital ecosystem with (digital) services designed around healthcare outcomes and facilitate and optimize patient participation. The elegance of a platform lies in the ability to provide an infrastructure for services, without the provider supplying these services. Development is facilitated by allowing other organizations to plug in to their system through application programming interfaces (APIs), which guard data integrity while providing access by functioning as a standard, well secured, connection for third parties.

Data Platforms as a Foundation for Change


Healthcare is the sum of many parts, there are organizations that pay for, coordinate, and deliver care. Simultaneously, there are systems that help people self-manage a lifestyle goal or healthcare condition. Effective healthcare requires these systems to communicate. Therefore, IT needs to become an enabler instead of a bottleneck. Platforms can provide the foundation for IT to become the next driver for change in healthcare.


A platform allows data sharing within and across networks, removing existing silos and transcending organizational boundaries. It can unlock data from (legacy) systems without altering these systems. While (legacy) systems continue to function as administration, existing data on patients, treatment and outcome can be made available, combined and stored. Using standard guidelines, such as the MedMij protocol developed by the Dutch Government, enables a secure exchange of medical data.


Healthcare enterprises increasingly look to include third parties into their platforms, 90% of health executives believe it’s critical to adopt a platform based business model and engage in ecosystems with digital partners. However, only 66% of the health organizations are taking steps to participate in ecosystems. There are three readily available digital innovations which help healthcare providers develop the capabilities that will enable operating in a platform environment:

  • Analytics
  • Connected Health
  • E-health

A platform can be a foundation for change and turn IT into a change enabler instead of a bottleneck. Defining a good starting point can be can be problematic. Many hospitals are already familiar with big data analytics, connected health or E-health which are all great starting points for platform development. Each contain vital attributes which, with the right guidance, can be developed into a value adding platform (see where to start). 

Figure 2: Possible platform starting points



Analytics is based on linking different data sources obtain to new insights, it requires significant amounts of data and infrastructure investments to succeed. These investments are slowly starting to pay off as hospitals are starting to use data to predict patterns of chronically ill patients. In the meantime, analytics capability is an excellent stepping stone to evolve into a platform.


Connected Health

Connected health uses healthcare information, technology, and changes, to ease access to and sharing of data, for instance through patient portals. The openness and accessibility delivered through connected health can be utilized and developed further into a platform. For example, the Isala clinic developed a patient portal Mijnisala.nl. Offering a wide variety of functionalities, it bundles all hospital specialties so it can optimally support the patient journey of each individual patient.



E-health is the use of technology in healthcare to support or improve patient health or general healthcare. Apps for example can be valuable tools for delivering additional information for diagnosis and disease progression, at a level of detail and frequency that vastly exceeds what was possible before, even saving lives. New data and insights like these can be a good starting point in platform development. For example, the Parkinson Smartwatch, participant in the Accenture Innovation Awards, cleverly utilizes technology to actively measure the condition of Parkinson Patients. Based on this data, doctors can prescribe treatments specifically altered to each patient.


Where to start?


Multiple care providers have already invested in digital innovation, their experiences help us understand the effective steps to developing healthcare platform solutions. A vital realization is that this isn’t just about technology. It’s a fundamentally different way of interacting with patients and delivering treatments and therefore should be embedded in the heart of the business and its culture.


Healthcare is about patient experience. It starts with creating patient stories from end-users or personas. Understanding the needs, desires and fears of these persona create a highly effective perspective for innovation, and in turn guide the organization in developing services and choosing technology.


The process of moving to a platform model must be flexible and iterative. Focus on developing a business case for services, start small, scale up and design for humans from the start. New design techniques such as design thinking, can be an effective way to enable better and patient centered care. This means deviating from the classic scientific waterfall approach where all details are established before starting. Instead, agile/scrum methodology gives quick and frequent results, showing improvement in small increments through end user input. The small but continuous progress greatly boosts acceptance and business value in the organization. This way, organizations can keep momentum during the transition in a rapidly changing environment.



Patient and Outcome Oriented Healthcare is the Future


Healthcare providers are realizing that healthcare delivery needs to change fast to keep it affordable, meet patients’ needs and allow for innovation. Through VBHC, focus can shift back to the patient and outcomes. Successful implementation will require a shift in organization and culture surrounding healthcare, both from professionals and consumers. Data siloes and rigid IT are currently bottlenecks for change and need to be passed to connect and analyze data, whilst being safe and secure.


Platforms can create ecosystems that unlock siloed data and enable flow and creation of new services around patient centered care. These new ecosystems will extend beyond technology to connect the capabilities, expertise and services that touch healthcare organizations, consumers and clinicians. Through new techniques such as agile/scrum and design thinking, the business is in the driving seat for change. Flexible, iterative development with end-users will result in a patient centered approach fitting to the individuals’ need.

Author: Lars Schoordijk


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