出版社：Utrecht University, Maastricht University, Groningen University
摘要：Introduction : Several countries adopted population management (PM) to achieve Berwick’s Triple Aim: simultaneously improving quality of care, improving population’s health, and reducing per capita costs. Also in the Netherlands, the concept of PM is embraced. In 2013, the Dutch Ministry of Health designated nine regional innovation initiatives as ‘pioneer sites’ in a nationwide effort to achieve a better health, improved quality of care and cost control (Triple Aim). The National Institute for Public Health and the Environment (RIVM) has monitored these sites with a particular focus on their design, the Triple Aim, and the experiences of members of the steering groups of the sites. In this presentation the development of the sites during the first 1,5 year are presented Methods : The following information about the pioneer sites is collected each quarter using interviews, published documents and websites: 1) aims of the PM site; 2) structure (legal entity, involved organizations and their roles, governance); 3) risk stratification and population identification; 4) financing and incentives; 5) included interventions; 6) barriers/facilitators. Next to this, sixty semi-structured interviews were conducted, including all members of the board of the nine pioneer sites. Interviewees’ roles varied, but they were mostly directors/ managers of care groups, hospitals and patient-organizations. The interviews focused on barriers and facilitators in achieving the sites ambitions. Additional elaborated themes were: 1) financial incentives/ contracts, 2) quality of care and 3) transparency of information between involved organizations. In addition data on the Triple Aim have been collected by using national registration data on costs (Vektis) and health (Dutch National health monitor) as well as an additional questionnaire among a randomized selected sample of the populations of the nine sites (in total n=5030) identify the quality of care. Results : Health care providers, insurers and often stakeholders like municipalities and representatives of citizens / patients are working jointly to achieve sustainable care and support. Based on a number of interventions they attempt to lay the foundation for the necessary cooperation, organization and funding of the sites. Pioneer sites are run by stakeholders’ representatives. According to them, first experiences indicate that cooperation has improved. At the same time, the sites are still seeking the best organizational and management structures to work with and exploring new forms of funding such as shared savings. Transparency between stakeholders is still limited. Consequently, pioneer sites could still not yet focus on the true needs of the population, insurers cannot optimally pay for performance and feedbackcycli are lacking or lack behind. Discussion and conclusion : For the pioneer sites to be successful, good cooperation is essential. This requires that organizational interests of all stakeholders are more aligned to the objectives of the pioneer sites. Alternative forms of funding as well as transparency of the quality and costs of care need attention.
