The Dutch health care performance report: seven years of health care performance assessment in the Netherlands

Abstract

In 2006, the first edition of a monitoring tool for the performance of the Dutch health care system was released: the Dutch Health Care Performance Report (DHCPR). The Netherlands was among the first countries in the world developing such a comprehensive tool for reporting performance on quality, access, and affordability of health care. The tool contains 125 performance indicators; the choice for specific indicators resulted from a dialogue between researchers and policy makers. In the ‘policy cycle’, the DHCPR can rationally be placed between evaluation (accountability) and agenda-setting (for strategic decision making). In this paper, we reflect on important lessons learned after seven years of health care system performance assessment. These lessons entail the importance of a good conceptual framework for health system performance assessment, the importance of repeated measurement, the strength of combining multiple perspectives (e.g., patient, professional, objective, subjective) on the same issue, the importance of a central role for the patients’ perspective in performance assessment, how to deal with the absence of data in relevant domains, the value of international benchmarking and the continuous exchange between researchers and policy makers.

Role of Patient and Practice Characteristics in Variance of Treatment Quality in Type 2 Diabetes between General Practices

“…Quality assessment frameworks have been introduced in several countries with the goal to ensure appropriate and evidence-based healthcare for patients [1]. Within such frameworks, guideline recommendations on optimal care are linked to performance measures and accountability processes.…”

“…When applying such measures in clinical practice, variation in the performance of healthcare providers and institutions is common. For example, prescribing of preferred drugs by Dutch general practitioners ranged from 35% to 95%, whereas prescribing drug treatment when indicated ranged from 60% to 95% [1]. Differences in performance may be attributed to the underlying patient population as well as to the healthcare provider and the practice organization.…”

Obstacles and opportunities in Chinese pharmaceutical innovation

“…For instance, lack of an efficient investment exit channel made it difficult for investors to withdraw capital gains. As a result, a lot of VC only paid attention to short-term and less innovative projects [7]. Volatility of stock markets, highly exaggerated price to earnings ratios, and lack of sophisticated secondary markets were also detrimental to the financing for high-risk new drug R&D projects [18, 33].…”

“…For instance, the ‘Key Drug Innovation project’ launched in 2007 was a notable example. During the entire 12th Five- Year Plan, the project ‘Key Drug Innovation’ was supported with about $16 billion USD from the central government and more than $49 million USD from local governments [7]. As the second largest R&D performer, comparison of the global compound annual growth rate of biomedical R&D expenditures by country, China showed the most rapid rise, from approximately $2.0 billion in 2007 to over $8.4 billion in 2012 with a compound annual growth rate of 32.8% [43].…”

“…With the perspective of switching from imitation to innovation, R&D expenditure in China’s pharmaceutical industry increased from $162.6 million USD (USA dollar) in 2000 to $3249.2 million USD in 2011 [7]. The favorable condition created by the tremendous investments made by Chinese pharmaceutical sector in R&D has resulted in significant global share of scientific publications and patents in recent years.…”