Scaling Care

__Abstract__ “The Cabinet will promote small-scale healthcare institutions. An optimal scale of healthcare institutions will lead to more efficiency, lower costs, more integrated care, higher customer satisfaction and better care. The Cabinet will ensure the optimisation of the scale of healthcare institutions. The rise of healthcare giants will be halted.” (VVD-CDA Coalition Agreement 2010: 36) This quote comes from the Coalition Agreement of the Liberal (VVD) and Christian-Democratic (CDA) cabinet (‘Rutte I’) that took office in the Netherlands in 2010. In the quote, the cabinet expresses several assumptions about scale. “Small-scale healthcare institutions” are preferred over “healthcare giants” because the former have an “optimal scale”. Moreover, this optimal scale results in “more efficiency, lower costs, more integrated care, higher customer satisfaction and better care”. These assumptions are exemplary for current thinking about scale in Dutch healthcare. In particular, the quote illustrates that a lot is expected of scale. According to the quote, scale can contribute to efficiency, affordability, integration, customer satisfaction and quality. As the following extracts from Dutch newspapers exemplify, this is a reflection of the public and political debate about scale (see also Postma, Putters and Van de Bovenkamp 2012). Especially the (positive) expectations of small-scale care are high: it is supposed to be “beneficial to healthcare” (Boersma 2005) because it entails “flexibility and a better working atmosphere” (Volkskrant 2001) and a “human, individual approach” (Lubbers 2009). In contrast, large-scale healthcare is frequently typified as “inhumane” (De Haan and Haagsma 1996) because it is based on a “production mind set” (Noordhuis 2008) and is “bureaucratic” (Van Dijk 2009). But actors also argue in favour of large-scale care because it ensures “better quality” (Hoekman 2008) and against small-scale care due to “problems of discontinuity” (Wammes 2009). The opinions that people express about scale are different, but have one thing in common: the high expectations of what scale can accomplish for the organization and provision of care

Huub Dijstelbloem - Het huis van Argus

_Vorig jaar verscheen_ ‘Het huis van Argus. De wakende blik in de democratie’ _van auteur Huub Dijstelbloem. Het boek bevat belangrijke aangrijpingspunten voor het doordenken van ontwikkelingen in het toezicht op de zorg en andere sectoren. Met name ten aanzien van het betrekken van burgers in het toezicht, een richting die verschillende toezichthouders exploreren. Wij vroegen Dijstelbloem daarom in een bijeenkomst in onze vakgroep Health Care Governance met ons van gedachten te wisselen over het boek. Ter voorbereiding schreef Jeroen Postma een review in de vorm van een verhaal. Deze recensie is een synthese van dat verhaal en de discussie over toezicht tijdens de bijeenkomst. Wij hebben het thema ‘verbeelding’ uit het boek gebruikt om Argus, genoemd naar de Griekse reus die honderd ogen bezat waarvan er nooit meer dan twee tegelijk rustten, tot leven te wekken en tevens kritisch te beschouwen.

Van optimale schaalgrootte naar legitieme schaalgrootte

In dit artikel identificeren we vijf waarden: sturing, menselijke maat, kwaliteit van zorg, marktmacht en efficiëntie, die ten grondslag liggen aan heersende opvattingen over schaalgrootte van zorgorganisaties. We beschrijven deze waarden vanuit de vier domeinen die typerend zijn voor de Nederlandse gezondheidszorg: overheid en politiek, gemeenschap, medische professie en markt. We baseren onze beschrijving op een analyse van het publieke debat over schaalgrootte van 1990 tot 2011

Use and the Users of a Patient Portal: Cross-Sectional Study

Background: Patient portals offer patients access to their medical information and tools to communicate with health care providers. It has been shown that patient portals have the potential to positively impact health outcomes and efficiency of health care. It is therefore important that health care organizations identify the patients who use or do not use the patient portal and explore the reasons in either case. The Unified Theory of Acceptance and Use of Technology (UTAUT) is a frequently used theory for explaining the use of information technology. It consists of the following constructs: performance expectancy, effort expectancy, social influence, facilitating conditions, and behavioral intention to use. Objective: This study aimed to explore the prevalence of patient portal use and the characteristics of patients who use or do not use a patient portal. The main constructs of UTAUT, together with demographics and disease- and care-related characteristics, have been measured to explore the predictive factors of portal use. Methods: A cross-sectional study was conducted in the outpatient departments for adult patients of a university hospital in the Netherlands. Following outcomes were included: self-reported portal use, characteristics of users such as demographics, diseaseand care-related data, eHealth literacy (modified score), and scores of UTAUT constructs. Descriptive analyses and univariate and multivariate logistic regression were also conducted. Results: In the analysis, 439 adult patients were included. Furthermore, 32.1% (141/439) identified as being a user of the patient portal; 31.2% (137/439) indicated as nonusers, but being aware of the existence of the portal; and 36.6% (161/439) as being nonusers not aware of the existence of the portal. In the entire study population, the factors of being chronically ill (odds ratio, OR 1.62, 95% CI 1.04-2.52) and eHealth literacy (modified score; OR 1.12, 95% CI 1.07-1.18) best predicted portal use. In users and nonusers who were aware of the portal, UTAUT constructs were added to the multivariate logistic regression, with chronically ill and modified eHealth literacy sum score. Effort expectancy (OR 13.02, 95% CI 5.68-29.87) and performance expectancy (OR 2.84, 95% CI 1.65-4.90) are shown to significantly influence portal use in this group. Conclusions: Approximately one-third of the patients of a university hospital self-reported using the patient portal; most expressed satisfaction. At first sight, being chronically ill and higher scores on the modified eHealth literacy scale explained portal use. Adding UTAUT constructs to the model revealed that effort expectancy (ease of use and knowledge and skills related to portal use) and performance expectancy (perceived usefulness) influenced portal use. Interventions to improve awareness of the portal and eHealth literacy skills of patients and further integration of the patient portal in usual face-to-face care are needed to increase use and potential subsequent patient benefits

Eindrapportage experiment TopZorg

TopZorg is een experiment waarin drie niet-universitaire ziekenhuizen – het St. Antonius Ziekenhuis (de domeinen hartaandoeningen en longziekten), het ETZ (neuro en traumazorg) en Het Oogziekenhuis (oogaandoeningen) – 28,8 miljoen euro hebben gekregen om in de periode 2014-2018 zeer specialistische zorg en wetenschappelijk onderzoek te bekostigen. De drie ziekenhuizen gaven aan dat ze deze combinatie van zorg en onderzoek al langer aanboden binnen de vijf domeinen, maar dat het door wijzigingen in de bekostigingssystematiek steeds moeilijker werd om dit te blijven doen. Niet-universitaire ziekenhuizen in Nederland hebben geen toegang tot structurele bekostiging voor zeer specialistische zorg en wetenschappelijk onderzoek. De belangrijkste doelstelling van het experiment is om de ‘maatschappelijke meerwaarde’ inzichtelijk te maken van het bekostigen van een combinatie van zeer specialistische zorg en onderzoek in niet-universitaire ziekenhuizen