Long range healthcare capacity planning in the Netherlands

Abstract

This contribution discusses centralization vs. decentralization in healthcare strategic decision making, focusing on long-range planning of facilities for radiotherapy. The radiotherapy case illustrates that more centralized, comprehensive, and systematic planning and strategic decisions making may be necessary to account for inputs of various parties and decision-making levels in this area. The expertise required cannot generally be found at a local or even regional level. It requires initiatives from coordinating healthcare institutions such as the Health Council and other professional organizations.

EUROCOURSE lessons learned from and for population-based cancer registries in Europe and their programme owners: Improving performance by research programming for public health and clinical evaluation

“…Some CRs also interacted with oncological care by developing scenario's (through trend analyses) for underpinning resource investments (e.g. for optimal delivery of radiotherapy), ever in need of adequate long-term planning everywhere due to preparation times of 10-20 years [26]. Such therapy scenarios might also be followed by a verifying CR research agenda of studies of adherence to care (lower in elderly patients?)…”

Radiotherapy cost-calculation and its impact on capacity planning

“…The interaction between epidemiological, demographic, technological and medical developments urges for a more centrally directed policy development at a higher (national or even supranational) level [6]. The interests of individual hospitals and of other parties in policy development can be more effectively matched and coordinated when taking all above parameters into consideration.…”

“…National capacity models for radiotherapy have been developed in The Netherlands, taking the distribution of cancer in the population, the medical views and guidelines for radiotherapy treatment (indications) and the availability of specific modalities, personnel and equipment to diagnose and treat patients, into account [6,7]. Based upon these parameters, the models allow making projections concerning the manpower and numbers of linear accelerators required.…”

“…It is therefore argued that long-range planning of radiotherapy facilities is best organized at the national level. Such a centralized model should not be seen as a rigid planning system involving the risks of formalization and regulation but conversely as one that allows bridging gaps between different experts and bringing together information and knowledge from various disciplines [6].…”

“…Moreover, 25-33% of all cancer patients need repeated radiotherapy treatments [5][6][7]. The reported differences in radiotherapy utilization are most likely to be due to a mixture of factors: the different availability of and/or access to modern screening, diagnostic and treatment facilities, international variations in the definition of new patients, differences in incidence of various tumor types, diverging referral and treatment policies, and the fact that these data were based on surveys, as well as estimates of opinion leaders.…”