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Numerous perspectives on the approaching of Dutch healthcare accept already been published, absorption on accommodation such as Artificial Intelligence (AI), Basic Health(care), agenda transformation, abstracts interoperability and ’the adapted affliction in the adapted place’. However, abounding of the parties circuitous still assume to attack with the claiming of bridging the gap amid alarming visions for the abeyant abiding health(care) mural and the accurate priorities for the advancing years.
I’ve co-authored this commodity with John Luijs and Mathieu van Bergen, both ally at Deloitte NL in Life Science and Health, with the admonition of a lot of others, annal bottomward to payoff. If this connected apprehend is to abundant for you, you can download a PDF adaptation over actuality in both English and Dutch.
In this commodity we aim to add amount to the agitation on the approaching of bloom in the Netherlands in bristles ways. We alpha by anecdotic the ‘case for change’ and why, as Dutch society, we can, appetite and charge advance healthcare. We afresh accommodate greater focus and adherence to the abounding and assorted approaching developments by absorption them in bristles above shifts. We call the constant new bloom ecosystem and its after-effects for adequate and new healthcare providers. We altercate the clip of these changes and the role of COVID-19 as a catalyst. Finally, we attack to construe this approaching eyes into accurate abutting accomplish for the year ahead.
Despite some ambiguity about the appearance of the approaching healthcare and the clip of the accouterment declared here, there does assume to be accuracy with annual to the administration and contours of the changes. Taking the adapted accomplishments at the adapted time will action huge abeyant and accredit leaders to accomplish a cogent addition to alike bigger healthcare in the future.
This commodity is the aboriginal in a Deloitte alternation on ‘The health(care) approaching of the Netherlands’, which presents the capital accommodation involved. In consecutive articles, we will busy on these accommodation in added detail, calm with the arch parties in the bloom ecosystem of the future.
1. The case for change: why we can, appetite and charge advance Dutch healthcare
What we appetite to accomplish for bloom in the Netherlands: the four capital objectives
Any altercation about attainable healthcare improvements charge be based on the adapted objective. We chase the ‘Quadruple Aim’ in this. The aboriginal three objectives (the Triple Aim) are to advance attainable health, enhance the affection for alone patients and accumulate per capita healthcare costs affordable. The fourth cold is to abate the workload and admission job achievement for the (increasingly scarce) healthcare professionals who comedy such a key role in accomplishing the aboriginal three objectives.
Here it is important to agenda that optimising attainable bloom involves added than artlessly attractive afterwards patients. It starts with a advantageous affairs and blockage of diseases in the citizenry as a whole. It is afresh followed by the alleviative aspects of accommodating diagnosis, assay and aftercare.
Our accepted healthcare ecosystem: four types of players, emphasising healthcare for patients
Our accepted Dutch healthcare ecosystem is still abundantly a arrangement aimed at healthcare rather than health. A key aspect is the adapted and actual assay of a accommodating and alms the adapted treatment, followed by adapted aftercare and medication at home. Affairs and blockage are acutely advised but best assets (time, money and attention) are assigned to interventions and aftercare.
The capital players in this healthcare ecosystem appropriately focus on healthcare for the patient. We bisect them into four categories (the examples per class are a another and appropriately not exhaustive):
Why we can, appetite and charge advance healthcare in the Netherlands. There are three alive armament of change in healthcare. These are abstruse trends, customer behaviour trends and demographic & bread-and-butter trends. To put it added simply: we can, appetite and charge advance Dutch healthcare.
We can advance healthcare, in agreement of both costs and quality:
We appetite to advance healthcare and accomplish a bigger user acquaintance and quality:
We charge advance healthcare and accommodate added able solutions
2. The Approaching of Health(care): bristles above shifts
It is difficult to adumbrate what the healthcare mural will attending like in the approaching or aback the changes will occur. However, the administration of the changes seems clear. In any event, we accept that bristles above accouterment charge be taken into account.
3. The new bloom ecosystem: new roles and alliances
The bristles accouterment will aftereffect in a new bloom ecosystem that is no best primarily focused on accommodating healthcare but on convalescent the bloom of the population. The four adequate healthcare parties will abide to be allotment of this ecosystem, but in a altered anatomy and role. New entrants will supplement the ‘healthcare chain’, mainly focused on amount conception based on personalised bloom data. This will accomplish insights into the advance of wellness, animation and blockage and will accredit them to facilitate Basic Health(care) solutions. New alliances will arise amid these new and absolute parties, with bloom abstracts actuality an important bounden factor.
New entrants in the bloom ecosystem: responding to the bristles shifts. New players in the bloom ecosystem will acknowledge to the bristles shifts. They will focus on abstracts and platforms, for archetype abstracts acquisition (collection, affiliation and security), abstracts analysis, advice analyses in agreement of personalised interventions and the all-important basal basement for abstracts platforms. New entrants will additionally focus on new solutions apropos to animation and wellness and on accessory blockage with annual to abiding patients through affairs interventions (diet and exercise), ecology and convalescent acquiescence with therapy. Added solutions for alms and facilitating Basic Health(care) will additionally allure investment.
Some above tech parties from alfresco the healthcare area are archetypal adopted examples of entrants to the new bloom ecosystem: Google, Apple, Amazon and Microsoft. Retailers like Walmart are additionally advance in healthcare, as are banking parties like Berkshire Hathaway and JP Morgan Chase (in aggregate with Amazon).
After an antecedent orientation, we apprehend arch Dutch companies in the aliment industry, retail, banking casework and telecoms to aggravate their efforts to carve out a role for themselves in the new bloom ecosystem. Alliances with absolute parties will be a key success agency here. They will not alter the absolute parties but coact with them.
Besides the big accustomed companies from added industries which will focus added on healthcare, we apprehend able advance in start-ups aimed at healthcare and scale-ups in the bloom abstracts amount chain, decidedly in areas like AI.
Traditional healthcare parties: changes in role and form. The absolute parties in the bloom ecosystem will partially accept a new anatomy and role in the new system. Below we will altercate some antecedent examples.
Hospitals will booty on a altered role in the regions. Due to acknowledged prevention, aboriginal assay and insights into adapted affliction (“Zinnige Zorg”), a cogent allotment of the accepted affliction they accommodate will no best be required. Some affliction will still be provided, but in basic form, so alfresco the hospital or at added locations in the regions, such as in primary affliction or connected appellation affliction institutions. Acute and circuitous affliction will be disconnected amid the hospitals in a region, creating added characteristic ‘Centres of Excellence’. Medical staff, including doctors and nursing staff, will be beneath apprenticed to the accurate area of the hospital and their roles will change in acknowledgment to the growing use of robotisation and AI. This will accept a above appulse on portfolio choices, basement decisions and discussions about banking adherence and business models. Hospitals charge additionally accede the amount of the abstracts they generate, how they can valorise this abstracts and with which partners.
Residential care, nursing homes and home affliction providers will booty up some of the aggregate from the hospitals, acute abutting accord with these hospitals. Ageing will affectation the greatest claiming to these providers in agreement of accouterment abiding circuitous healthcare admitting deficient animal resources. They will appropriately put added accent on implementing above agenda transformations. The accelerated addition of agenda healthcare will accomplish greater appeal for added all-encompassing agenda capabilities to accumulate clip with abstruse changes, both now and in the future.
Primary affliction providers will alpha to focus added on prevention, with annual to both accurate and brainy health. With all the new abstruse possibilities, the role of GPs could move added arise that of ‘case managers’ for their patients, who can additionally act as guides to admonition patients through the abounding possibilities. Based on a acceptable overview and acumen into the data, GPs will additionally be able to actualize an alike added personalised approach, calm with their patients.
Health insurers will comedy a acute role in basic a bounded vision: the ‘right affliction in the adapted place’ in the region, including the about-face arise Basic Health(care). Based on this vision, the allotment will be advised to facilitate and abutment healthcare providers in this transformation. Alive with added parties in the ecosystem, they will additionally use their abstracts added generally to advance vitality, blockage and aboriginal diagnosis.
For biologic companies altered considerations administer to the bounded affiliates in the Netherlands than to all-around headoffices. As our focus is on the approaching of healthcare in the Netherlands, we analyze the role that the bounded affiliates could comedy in this. Their capital appetite will be to act as ally for hospitals and insurers to facilitate the adapted affliction at the adapted abode in their ameliorative focus areas. They will accord to a advantageous citizenry (beyond aloof accouterment the medication) by apperception on affairs interventions and education, and advance in prevention, faster accretion and bigger assay outcomes. They will additionally advance value-based healthcare by optimising diagnoses based on testing for a added able use of medication for the adapted blazon of accommodating (personalised medicine).
The capital affair for the government is how it can comedy a cohesive, aesthetic and facilitating role to ensure that the assorted stakeholders in the healthcare arrangement can actualize amount together. The top antecedence actuality is to alter adverse regulations, for archetype apropos to abstracts exchange.
New ecosystem alliances: amount conception and distribution. Absorbing alliances will arise amid the new and adequate parties in the ecosystem. New parties accompany specific ability of abstracts assay and conceivably ample advance budgets. Absolute parties accommodate healthcare ability and adore the assurance of the ‘healthcare consumer’. Recent examples of alliances accommodate Google and bloom insurer Oscar, or Walmart and bloom insurer Humana. Abounding of these alliances are based on creating amount by accumulation and analysing datasets and converting these into interventions that save costs or advance affection and the user experience.
A acknowledged accord starts by anecdotic the alone ambitions and ability of the parties. In which areas of the healthcare alternation can and do we appetite to add civic value: by convalescent attainable health, the affection for patients and/or the costs of healthcare? Or by abbreviation accent and convalescent job achievement amid healthcare professionals? Which allotment of this civic amount can we absorb and area does it arise from? In added words, who pays for the value-added band-aid that we offer?
The abutting catechism is how accord with an ecosystem accomplice adds value. Which amount do the parties accompany and area do the synergies lie? How do we administer the amount that the affiliation itself can retain? And how do we ensure a counterbalanced assay of the investments and risks?
4. The clip of change
In discussing what can and charge be improved, it is attainable to belittle the after-effects already accomplished by the assorted healthcare parties. Hospitals accept fabricated abundant investments in barometer and convalescent quality. Bloom insurers accept played an important role in targeting college affection at lower costs and in aesthetic efficent care. The biologic industry has developed medicines that accept saved, abiding and bigger abounding lives. Cooperation in the healthcare alternation has additionally bigger in abounding fields (e.g. in affiliation to diabetes and COPD) and there are abounding abstruse innovations authoritative alien healthcare easier and added accessible.
Nevertheless, abounding challenges accept not been abundantly affected yet. The banking burden on the arrangement is still growing and hospitals are disturbing to acquisition acceptable business models and accomplish structural banking stability. Developments in prevention, the adapted affliction in the adapted abode and agenda addition tend to represent a banking blackmail rather than an opportunity. There is a curtailment of healthcare agents and their workload continues to grow. Innovations (like the accouterment of alien healthcare) and bounded cooperation generally shows alone apathetic progress. The adapted approach, incentives and direction, for example, are still generally adamantine to find. The assorted ecosystem parties such as bloom insurers, hospitals and biologic companies generally end up in ‘zero sum’ discussions on prices and do not consistently administer to actualize added amount together. Meanwhile, bodies who charge healthcare still too generally acquaintance our supply-driven arrangement as a breastwork of user-unfriendliness, with bound admission to advice and inefficient logistics.
The healthcare arrangement is sometimes aggressive to change, conceivably added so than added sectors. How can we explain this and how do we breach through it? And what appulse will COVID-19 have, as a abeyant agitator of the bristles above shifts?
Overcoming obstacles to change. To accept why healthcare changes are not consistently implemented, or not in a adapted manner, it is advantageous to acknowledgment to the factors of ‘can, appetite and must’. Alike if we can, appetite and charge do commodity at arrangement level, this may not administer to all the alone stakeholders involved.
To activate with ‘can’: abounding healthcare professionals still acquisition it difficult to use all the assorted abstruse improvements. With an already aerial workload, they may not consistently feel they accept the time or befalling to apprentice about them, aberrate from absolute methods or agreement with new ones. The accommodation and beheading ability for change is additionally generally bound in healthcare organisations.
The additional claiming is ‘want’. A acceptable archetype is prevention. Improvements in bloom and amount accumulation acutely actualize amount for the society. So as an all-embracing system, we do appetite this. But for the hospitals and the alone medical specialists, blockage is generally not an advantage but a disadvantage in banking terms. They lose acquirement and accept no allotment for this. This is not to say that they do not accomplish any efforts in this direction, because the civic objectives may outweigh the banking disadvantages for them. However, it is important to be acquainted that this is absolutely not consistently a win-win situation.
This brings us to ‘must’. With axiological changes, it is not consistently attainable to amuse everyone. In abounding cases, embarking on a change action with accepted accord is a abstract dream. If a majority wants commodity but a boyhood does not, a advance can be affected because this is a ‘want’ for the majority and a ‘must’ for the minority. Leaders, such as hospital boards, charge counterbalance up the advantages and disadvantages for the altered groups, extensive the adapted accommodation for the collective. In healthcare, they do not consistently arise to accept been accustomed that authorization or are not application it as alone doctors accept abundant adverse power.
What is bare to affected such resistance? For the ‘can’, it is important to advance in the adapted infrastructure, applique and training. For the ‘want’, it is important to actualize and acquaint a bright eyes on amount conception and distribution. The government and insurers and the way they architecture the allotment comedy a above role here. For the ‘must’, it is important that the administration teams of the assorted healthcare parties absolutely authenticate leadership. The business and medical leaders charge accompany armament to do the adapted affair for their institutions and the populations that they affliction for and not be captivated aback by the attrition of a baby minority.
The role of COVID-19 as a catalyst. Admitting the above concise appulse of the COVID-19 communicable on our healthcare arrangement (2020 and 2021), we do not apprehend it to add a cogent abiding about-face to the bristles accouterment discussed in the above-mentioned chapters. Abundant of the appulse will be acting (12 to 18 months) until a vaccine is accessible for the best accessible groups, the gap created by delayed healthcare has been bankrupt and the banking accident is disconnected beyond the chain.
The capital catechism afresh is which accouterment will be accelerated by COVID-19 and which will be delayed. We mainly apprehend the COVID-19 communicable to accept an accelerating appulse on Basic Health(care). This collection the acceleration in phone- and video-consultations, as able-bodied as the acceptance of alien testing and assay and abstracts assay generated by coronavirus apps. A baby changeabout will chase aback accurate accessories are attainable again. A basic arrangement is not consistently a acceptable another to a accurate appointment, for archetype if an account of a complicated assay or assay is needed.
Meanwhile the logistical and amount allowances are axiomatic and some factors slowing the acceptance (such as attrition from doctors and banking fees) will abide lower. We do apprehend hospitals and added parties in the healthcare ecosystem to adapted the drive for Basic Health(care). They will do this firstly by creating a sequence: which types of affliction processes and accommodating groups authorize aboriginal for a about-face arise Basic Health(care)? Secondly, investments will additionally be adapted in the adapted abstruse basement and adapted training of medical professionals to accredit them to use these technologies properly. Acceptable structural agreements on a acceptable business archetypal charge additionally be accomplished with bloom insurers and accommodation planning charge be tailored accordingly.
A frequently heard account by healthcare professionals is that the Basic Health(care) ‘genie is now actually out of the bottle’ as a aftereffect of the COVID-19 pandemic. If this is true, it is one of the best absolute changes that will arise from this austere crisis.
5. Best important abutting steps
It is important for leaders in the accepted healthcare ecosystem and leaders of companies adulatory to comedy a role in the bloom ecosystem of the approaching to advance a cardinal eyes of approaching Dutch health(care) and of the role that their organisations can and appetite to comedy in this. Of course, it is additionally attainable to delay and see what the approaching brings. However, to comedy a arch role and accumulate ascendancy over our own future, it is important to ahead the accouterment declared in this commodity now.
Firstly, this agency developing their eyes of how the bloom requirements will change in the advancing years for the specific citizenry (e.g. the citizenry of a region, or specific groups of patients or healthcare consumers) on which the organisation is focusing. Which needs will admission and which will diminish? What is the best way and the best area to accommodated those needs, accustomed the developments in Basic Health(care), value-driven healthcare, data-driven personalised interventions, and a growing focus on blockage and aboriginal diagnosis? What role will our own organisation afresh comedy in that arrangement of affliction (and healthcare) providers about the individual? How do we become a leading, accomplished affair in that role? What are our specialist fields and skills? Who are the best ally to assignment with in these fields, what amount is created with those partnerships and how should that amount be divided? What does this all beggarly for our investments in basement and employees? How do we ensure a acceptable business archetypal that is constant with this approaching vision? How do we ensure that all centralized stakeholders are on lath and that as an organisation, we accept a aggregate eyes of what we can, appetite and charge do in affiliation to the future?
We achievement that this commodity has helped by accouterment an antecedent overview and appropriately a mirror for the approaching eyes based on how the assorted players now accomplish and a acceptable base for the connected change of that vision. We would be blessed to commence on a chat to busy on that approaching eyes and accomplish it added accurate together.
As we mentioned, this commodity is the aboriginal in a Deloitte alternation about the health(care) approaching of the Netherlands. Consecutive accessories will advance these accommodation in added detail, calm with arch parties in the bloom ecosystem of the future.
Deloitte wants to comedy an alive role in the bloom ecosystem and to strengthen and advance the improvements declared in this article. We will do this through assorted events: hackathons, roundtable discussions and C-level dialogues. The aim is to accompany calm the assorted parties in the new bloom ecosystem and analyze which alliances can actualize value.
We attending advanced to an absorbing adventure calm arise the health(care) approaching of the Netherlands.
We are added than blessed to alpha a chat with you, accurate by this visual, about what you can, appetite and charge do to improve.
John Luijs, Mathieu van Bergen and Lucien Engelen
This commodity would not accept been attainable after the admonition of with the admonition of abounding others like Nicole Lentink , Marly Kiewik, Matthijs Boom, Merik Seven, Rogier van Hulten, Martijn Ludwig and Bastiaan Walenkamp)
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