Lessons NHS CFOs learned about the Dutch healthcare system during the HFMA / LOGEX Study Trip
The UK and NL are geographically close, but there are vast differences in how the two countries view and organise healthcare. This can be regarded as an opportunity to learn from one another. That is why a group of 12 NHS CFOs and CMOs headed to the Netherlands over the summer for an inspiring study trip organised by HFMA and LOGEX.
During the trip, the group visited two Dutch university hospitals (Amsterdam UMC and Radboudumc). At these hospitals, sessions took place with the respective Directors of Finances (Ingrid Hissink at Amsterdam UMC and Mark Janssen at Radboudumc) and with other speakers to learn about these hospitals, as well as about the Dutch healthcare system.
One of the main differences noted by the group was the strict Dutch distinction between primary, secondary, and tertiary care, with each level functioning as a gatekeeper for the higher level of care. This system has the clear ambition to offer care at the lowest possible level, as that level offers the most cost-effective care. This way of working frees up capacity at the higher level of care to work on complex cases. It also allows university hospitals to reserve more resources for performing scientific research and developing new treatments.
In the UK, this works differently. Professor Kiran Patel CMO at University Hospital Coventry and Warwickshire NHS Trust said: “In England, we are not clear about where our boundaries of responsibility in accountability live. Patients come to where the light bulbs are on 24/7. Access to the acute hospital is always there. So we tend to absorb everything.”
Brian Shipley, Deputy CFO at Northern Lincolnshire and Goole NHS Foundation Trust thinks the distinction and focus do not only lead to more efficient use of resources but also to increased quality of care: “Our university hospitals still do everything. We are all trying to be excellent at everything. Instead, we should focus on having centres of excellence.”
There were also some concerns about the Dutch healthcare system. One of the main ones was how care funding is arranged in the Netherlands. In the UK, the funding of care is very straightforward: the NHS is the organisation that funds healthcare providers. That is different in the Netherlands. Healthcare is primarily paid for through taxes. But, to raise awareness amongst healthcare consumers about the fact that healthcare is not free, there is also a system with healthcare insurance. All citizens in the Netherlands must take out a basic package of healthcare insurance at one of the circa 10 available providers. The government determines the coverage of the basic package, so it is identical for all providers. On top of the basic package, people can choose additional coverage packages if they want to. These packages and prices vary between different providers. The insurance providers operate in a semi-free market, so they are incentivised to maximise their profits. One way of doing this is to offer the lowest possible reimbursement to healthcare providers for care activities. This causes an annual cycle of negotiations between all Dutch hospitals and healthcare insurance providers about reimbursement for care activities.
Paul Dunn, Executive Director of Finance at Northumbria Healthcare NHS Foundation Trust said: “It seems there is an awful lot of contracting that Dutch hospitals need to do to sort out funding, which is more complex than our system”.
Lee Outhwaite, Director of financing and contracting at Chesterfield Royal NHS Foundation Trust and Derbyshire Community Health Services, seconds that: “There is something about the simplicity of the UK system. There is one payer. This probably drives a more efficient process into the system without the complexity of that multiple insurance model. Being used to the UK system, we look at the Dutch system and think, ‘Crikey, how do you make that work then?’”.
Not only does the UK’s one-payer system seem less complex, but it also makes room for a more holistic approach to healthcare and well-being, including elements like prevention. Paul Antunes-Goncalves, Acting Director of Finance at Nottingham University Hospital, said: “The Dutch system doesn’t seem to offer incentives for prevention. The financial reimbursement mechanism isn’t there. So I wonder how the insurance market will have to adapt to that move towards prevention.”
This does not mean there was any doubt within the group about the intentions of healthcare providers in the Netherlands to consider the well-being of citizens beyond the cure portion of healthcare. The visit to the new building of Radboudumc gave some excellent insights into the commitment of the healthcare providers to stimulate the well-being of patients and visitors to the hospitals. The new building combines smart technology and recovery-stimulating interior design and architecture.
Paul Antunes-Goncalves said: “It is fantastic how they’re bringing wellbeing into the care and stress the importance of the environment at the forefront of the estate’s design. That was very insightful. The more practical matters, like the chairs and the curtains, are all in line with infection control measures, but they make it feel more homely, less like a hospital. More supportive of people’s recovery”.
At the end of the trip, when asked if the trip had met their expectations, each group member confirmed that it had. Lee Outhwaite explained that the geographical distance from the day-to-day that comes with a trip like this is invaluable: “I think you sometimes need the benefit of being away from your home patch and desk to be able to see slightly more clearly what’s going on back at the ranch. When you’re in the grip of it and trying to deal with how to try and create a more sustainable healthcare system, there is something about stepping away from it and seeing how other people are coping with that that can inform your professional practice back at home.”
Brian Shipley confirmed this: “It’s been really, really insightful. Not only to be able to talk to other colleagues, but to get a different opinion of how we do things compared to another country is quite interesting.”