Appropriate care

Appropriate care is the approach to care delivery in the Netherlands for keeping care good, accessible and affordable for all. Everyone in the healthcare sector is working on this: healthcare professionals, patients’ organisations, health insurers and the government. The National Health Care Institute is working hard with them to make appropriate care a reality.

What is appropriate care?

Appropriate care should make sure that everyone can continue to get the care they need. Appropriate care lets healthcare professionals, patients’ organisations, health insurers and the government improve how care is provided and paid for. It is done using the 4 principles of appropriate care, which are: 

  1. Appropriate care is care that works, for a reasonable price.
  2. Where possible, appropriate care is arranged close to the patient. 
  3. In appropriate care, patients decide along with their doctor what is the best possible treatment for them. 
  4. Appropriate care is not just about illness but also about health and a focus on what the individual is capable of doing. 

Organising care differently means we can waste less time and money on care that is not needed and does not work. An example: surgery on a torn meniscus (the tendon in the knee) caused by wear and tear is almost always unnecessary care. Research at Radboudumc has shown that people affected by this are usually better helped by tips for preventing symptoms and by physiotherapy. The € 11 million to € 26 million saved annually by avoiding unnecessary surgery could be spent on necessary, appropriate care.

Because appropriate care also focuses on health and disease prevention, it goes beyond the actual provision of care. It is also, for instance, about providing assistance for people in their own neighbourhood or environment. In appropriate care, healthcare professionals collaborate with social care providers as necessary, for instance from municipalities or volunteer organisations. 

Why is appropriate care needed?

In 2022, the National Health Care Institute concentrated on the major problems looming in the healthcare sector through its campaign #DeZorgVanMorgen (Tomorrow’s Care). The ageing population means that more and more people are needing care for longer and the number of people with chronic diseases is increasing. Whereas there are fewer and fewer staff to provide all the care. In its report ‘Kiezen voor houdbare zorg’ (Choosing sustainable care, 2021), the Scientific Council for Government Policy (WRR) already made things abundantly clear: if we don’t all do something about it, one in three Dutch people will have to be working in the care sector within 40 years. That figure is currently 1 in 7. More (and more expensive) medicinal products and technologies are also emerging and healthcare costs are rising too fast as a result. If we fail to change this, it will soon be impossible for everyone to get good care. 

What steps have been taken?

At the end of 2020, the National Health Care Institute and the Dutch Health care Authority (NZa) published an advisory report entitled ‘Samenwerken aan passende zorg: de toekomst is nú’ (Working together on appropriate care: the future is now). This states what is needed for making appropriate care a reality. One key condition, for instance, is that all the stakeholders must feel responsible and all agree that we can only get it done together. Important steps were taken in 2022 towards that goal: 

  1. In June 2022, the National Health Care Institute published the ‘Kader Passende zorg’ (Appropriate Care Framework). This expresses the four tenets of appropriate care in 12 concrete guiding principles. They state what the stakeholders (such as GPs, the patients themselves, hospitals, health insurers and the governmental authorities) should do to achieve appropriate care. 
  2. The Appropriate Care Framework is the foundation underpinning the Integrated Care Agreement (IZA). The IZA contains all the agreements for organising and funding appropriate care in primary healthcare, home care services and district nursing, hospital care and mental healthcare. The IZA has been signed not only by all the healthcare stakeholders but also by the Association of Dutch Municipalities. The IZA contains agreements for making the – usually separate – worlds of care and welfare work together more, aiming to provide the right care for people in the right place. That is because medical treatment is by no means always the correct care. For example, it is better to help people in debt get their lives back on track rather than just treating the symptoms caused by the stress of being in debt. 

What steps are we taking now?

Thanks to the IZA (plus the other healthcare agreements WOZO and GALA), appropriate care has entered its next phase in 2022, progressing from thinking to doing. All the stakeholders are working together to provide appropriate care. A great deal is happening! At the National Health Care Institute too: we are working on or involved in the implementation of a large number of IZA agreements. Our main task is to make sure that the insured package is managed appropriately. Appropriate package management means that we no longer only ask whether care works and for whom but also impose conditions on how care may be provided and by whom.