GP visits excluded from Netherlands' no claims bonus scheme
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《英国医生杂志》
The Dutch parliament has voted to scrap plans to include visits to or from general practitioners (GPs) in their proposed "no claim bonus" scheme for public health insurance.
The proposed plan would have meant that patients who used the health service infrequently would have had their rebate reduced every time they saw their family doctor. MPs felt that there should be no disincentive for patients to see their GP, so voted the plan down.
Because this will raise the cost of the scheme, the government is demanding 4% efficiency savings from general practitioners to compensate for the predicted loss of savings.
The Dutch Association of General Practitioners has called these savings an "attack on the quality of GP care" and the "straw that broke the camel抯 back." It is planning a campaign, including possible strikes, against what it sees as a 4% cut.
The no claim scheme, starting on 1 January, will now mean that patients whose hospital and pharmacy care costs less than �255 (?77; $319) each year will get the balance returned, as a reward for low use of health services. The scheme will be funded through an extra �68 on annual health insurance premiums. The government expects the scheme to save a total of �1.66bn.
The scheme had included general practitioners, with every visit or out of hours call knocking �5 off the annual reimbursement. But most members of parliament were convinced by arguments in more than 1300 letters from general practitioners that access to primary care must have no threshold.
The letters accused the scheme of being a "lottery for healthy people" that "punished" patients for visiting their general practitioners. The Dutch Association of General Practitioners called the scheme "medically irresponsible," affecting the "most vulnerable groups—elderly, chronically sick, and people on the lowest incomes."
But under the deal struck with members of parliament, the government now needs to recoup the �90m lost by excluding primary care. The government is seeking 4% efficiency savings through reducing "unnecessary" general practitioner visits. A plan to spend �50m on improving primary care will also be scrapped.
Christian Democrat member of parliament and former general practitioner Siem Buijs believes the deal is "for the good of the patient." He argued that visits to general practitioners for routine checks such as blood pressure and blood sugar concentrations could be reduced by greater use of support staff.
But Fulco Seegers, spokesman for the association said, "One of the characteristics of Dutch GP care is its efficiency. These 4% efficiency savings are just a cut in the quality of GP care. Any savings in the no claim scheme are just transferred to the backs of GPs."
Earlier this year, a study by the Dutch Institute for Health Services Research (Nivel) found that the efficiency of general practitioners had improved: they handled 96% of medical requests with 3% of the total health budget (bmj.com, 24 Apr 2004, News Extra).
Health minister Hans Hoogervorst has argued that the no claim scheme is unique for rewarding healthy behaviour rather than punishing illness. It would make people more conscious of health costs encouraging them not to "visit their doctor for every little trifle."
On average, patients are estimated to receive �20 more back than the increased premiums that they will pay. But about five million people—slightly more than half of the population—are expected to lose out. Opposition members of parliament argue that the burden will fall on chronically sick, handicapped, and elderly people.(Utrecht Tony Sheldon)
The proposed plan would have meant that patients who used the health service infrequently would have had their rebate reduced every time they saw their family doctor. MPs felt that there should be no disincentive for patients to see their GP, so voted the plan down.
Because this will raise the cost of the scheme, the government is demanding 4% efficiency savings from general practitioners to compensate for the predicted loss of savings.
The Dutch Association of General Practitioners has called these savings an "attack on the quality of GP care" and the "straw that broke the camel抯 back." It is planning a campaign, including possible strikes, against what it sees as a 4% cut.
The no claim scheme, starting on 1 January, will now mean that patients whose hospital and pharmacy care costs less than �255 (?77; $319) each year will get the balance returned, as a reward for low use of health services. The scheme will be funded through an extra �68 on annual health insurance premiums. The government expects the scheme to save a total of �1.66bn.
The scheme had included general practitioners, with every visit or out of hours call knocking �5 off the annual reimbursement. But most members of parliament were convinced by arguments in more than 1300 letters from general practitioners that access to primary care must have no threshold.
The letters accused the scheme of being a "lottery for healthy people" that "punished" patients for visiting their general practitioners. The Dutch Association of General Practitioners called the scheme "medically irresponsible," affecting the "most vulnerable groups—elderly, chronically sick, and people on the lowest incomes."
But under the deal struck with members of parliament, the government now needs to recoup the �90m lost by excluding primary care. The government is seeking 4% efficiency savings through reducing "unnecessary" general practitioner visits. A plan to spend �50m on improving primary care will also be scrapped.
Christian Democrat member of parliament and former general practitioner Siem Buijs believes the deal is "for the good of the patient." He argued that visits to general practitioners for routine checks such as blood pressure and blood sugar concentrations could be reduced by greater use of support staff.
But Fulco Seegers, spokesman for the association said, "One of the characteristics of Dutch GP care is its efficiency. These 4% efficiency savings are just a cut in the quality of GP care. Any savings in the no claim scheme are just transferred to the backs of GPs."
Earlier this year, a study by the Dutch Institute for Health Services Research (Nivel) found that the efficiency of general practitioners had improved: they handled 96% of medical requests with 3% of the total health budget (bmj.com, 24 Apr 2004, News Extra).
Health minister Hans Hoogervorst has argued that the no claim scheme is unique for rewarding healthy behaviour rather than punishing illness. It would make people more conscious of health costs encouraging them not to "visit their doctor for every little trifle."
On average, patients are estimated to receive �20 more back than the increased premiums that they will pay. But about five million people—slightly more than half of the population—are expected to lose out. Opposition members of parliament argue that the burden will fall on chronically sick, handicapped, and elderly people.(Utrecht Tony Sheldon)