Approaches to integrated diabetes care in the Netherlands

The Dutch health-care system has undergone major changes in the last decade and is still in a process of change. Coming from a dual insurance system with private and public insurance (based on income and/or profession), it has been transformed from 2006 onwards to a unified system governed by market forces (involving both health-care providers and insurance companies) with at the same time a fixed ceiling of expenditure. Individual health-care insurance is built using modular packages (providing specific care) with the insurance premium going up with higher numbers of modules. This is on top of a basic insurance package determined by the government. Health-care costs tend to rise continually which will potentially lead to a situation that innovative treatments can only be accommodated at the expense of other and/or older treatments. General practitioner care (community care) provides health care to many patients with diabetes, usually type 2 diabetes on oral medication or simple insulin regimens. Patients with complex type 2, type 1 and secondary diabetes usually need hospital care. These two care systems are financed independently and are mutually exclusive. Results of experiments with Care Groups in community care, that also determine form and content of hospital care have been inconclusive. Policy for the coming years is directed at organising equal partnering between community care and hospital care, hopefully facilitating easy transfer of patients between community care and hospital care facilities (the Dutch polder model).