In the Netherlands, the focus lies on the annual contracting of healthcare providers. This causes uncertainty among healthcare providers and their financers. In addition, annual renegotiations between healthcare providers and purchasers mean organisational costs are high.
The Scottish system is also based on a strict divide between healthcare providers and healthcare purchasers. In Scotland, the latter are called commissioners. They purchase care for the region they represent. Because healthcare providers, such as hospitals, often cater to more than one region, they often have to deal with more than one purchaser, just like in the Netherlands. All healthcare purchasers also have to deal with providers outside of their own region, as their clients are not obliged to obtain care from their own region.
Difference with the Netherlands
During the process of purchasing, commissioners pay attention to quantity, price and quality of care. In short, the Scottish system of healthcare purchasers and healthcare providers is similar to that in the Netherlands. However, there is one big difference: the Scots purchase care for several years at once. This is called strategic commissioning. Healthcare providers lose their multiyear contract when they do not provide as agreed. Although additional agreements about quantities, prices and quality are made each year, no significant changes are made throughout the duration of the contract.
For strategic purchasing, purchasers are initially guided by the quotations and plans presented to them by healthcare providers. However, they also use information about healthcare providers in past years and about trends in their own region. About the expected number of dementia patients for example. They also use results of innovations that have been realised in Scotland and elsewhere. Since 2009, the Scots have managed to turn the annual increase in emergency hospital admissions into a decrease, all thanks to strategic commissioning.
Chain care congress
I learnt all this information during lectures given by Alison Taylor and Margaret Whoriskey on March the 27th in Edinburgh. Both women hold important posts at the Scottish Ministry for Public Health. Their speeches marked the end of the fifteenth international congress about chain care hosted by the International Foundation of Integrated Care (IFIC). Soon, Power Point presentations made by these two speakers will appear on the IFIC-website.