Tackling the burden of chronic diseases: the ‘health by all’—strategy

TREND: The Netherlands does not differ from most other Western countries. An enormous increase of people with chronic conditions is expected in the near future. According to epidemiological estimations, heart failure, COPD, diabetes and obesity will e.g. rise with more than 40% between 2005 and 2025. This trend has huge implications both for the lives of individuals as well as for society as a whole. It will negatively affect social or labour participation, increase the costs of health care and alter the type of health care that is required. NATIONAL STRATEGIC FRAMEWORK: For this reason, the Dutch government published a national strategic framework regarding chronic diseases in June 2008. The strategy is based on four ambitions: • Curbing the rise of people with a chronic condition; • Delaying the age at which a chronic condition manifest firstly; • Preventing or delaying the onset of complications; • Enabling patients to cope with their chronic condition to improve their quality of life. To achieve these ambitions a programmatic approach, based on the disease management concept, is needed. This approach should be patient-focused, multi-disciplinary, transparent and cost-efficient. A shift must be made from a strongly fragmentized care delivery towards integrated health care encompassing prevention, early recognition, self management and adequate health and social care. In 2006, the Netherlands introduced a new health care system. This system is an important basis for the necessary reforms. It is essential that all stakeholders—patients, care providers, health insurers and government—take their responsibilities. This requires a balanced set of mechanisms, containing for instance the development of integrated health care standards; transparency and financial incentives (e.g. integrated financing of care providers and risk compensation for health insurers).