Summary of the Comprehensive Care Agreement (IZA)

The healthcare sector is under pressure

Good healthcare, accessible to everyone. And healthcare that is affordable. We in the Netherlands consider this important – for ourselves, for our family and friends, and for society as a whole. But it is becoming increasingly difficult to continue providing that care. If we do nothing, things will go wrong. So, to ensure good healthcare, both now and in the future, we must all work together. This is something we must do together: the healthcare sector, politicians and, in fact, everyone in the Netherlands.

Healthcare staff are experts in their field, well-trained and motivated. They carry out their work with great dedication to the patient or client. However, the workload is often too high to sustain this over the long term. This became even more apparent during the coronavirus crisis. Staff have to deal with a lot of administrative red tape. They also often feel they have little freedom in their day-to-day work. The high workload means that many staff are absent due to illness. Or they look for another job. This, in turn, increases the workload even further.

Good, accessible and affordable healthcare therefore calls for action. The government, local authorities, healthcare providers, health insurers, healthcare staff and patient organisations have therefore reached agreements. These agreements are set out in the Comprehensive Healthcare Agreement.

Access to healthcare is not equal

The demand for healthcare continues to rise. We are living longer, and as a result there are an increasing number of older people relative to the working population. More and more expensive treatments are becoming available. Many illnesses that used to be fatal can now be survived. But this often requires a great deal of medication and intensive care.

There is already a shortage of healthcare staff. We are seeing these shortages almost everywhere: among GPs, hospital specialists and in mental health care. The result: long waiting lists. Community nursing services and hospital A&E departments are also overwhelmed. Local authorities, too, face major challenges. They are responsible for providing support to vulnerable people. But there are staff shortages there as well. As a result, people do not always receive the care they need in time.

Moreover, access to healthcare is not the same for everyone. Even in the prosperous Netherlands, it still matters where you were born and where you live. People on low incomes, with little education, or those with a (learning) disability often face multiple challenges. They do not always know their way around the healthcare system. As a result, health and quality of life are unevenly distributed. On average, people on low incomes and with little education also have shorter life expectancies.

The quality of care is under pressure

Healthcare in the Netherlands is of a high standard. We can be proud of that. People working in healthcare are committed, motivated and very well trained. Yet we see that some of the countries around us are actually performing better than us when it comes to certain illnesses. And we cannot always prove that the care we provide is actually beneficial. This is not good for patients.

Not all problems require a medical solution. Sometimes, for example, support from social services is better than a visit to the doctor or medication. For instance, when it comes to loneliness or poverty. To make this happen, better cooperation is needed. This won’t happen by itself; doctors, community nurses and local authorities need laws and systems to help them achieve this. We need a shift from ‘caring for people’ to ‘caring with people’.

Will healthcare remain affordable?

If we do not take action, by 2060 we will be spending three times as much on healthcare as we do now. That is not feasible, nor is it what we want. After all, as a society, we also need to spend money on other major issues such as climate change, housing, security and education. We will, however, continue to spend more on healthcare in the coming years. This is necessary because demand for healthcare continues to grow. This is partly due to the fact that there are an increasing number of older people. New, expensive treatments and medicines – for example, in the treatment of cancer – also cost more. Expenditure will therefore continue to rise, but the rate of increase must be slower than it is at present.

At present, one in six workers in the Netherlands works in the healthcare sector. If we carry on as we are, by 2040 one in four workers would have to work in healthcare. That is neither desirable nor feasible. After all, we want affordable healthcare. Nor can so many more people work in the healthcare sector. After all, workers are also needed in other sectors, such as the police or education.

What are we going to do?

• Everyone should be able to receive the care they need. That care must remain of a high standard. We take account of the differences between people.
• A strong focus on health and wellbeing, so that people are and remain as healthy as possible. We want to prevent people from becoming ill or their condition from worsening. This means we must help people lead a healthy lifestyle and ensure they are able to look after themselves properly. If people smoke and drink less and are less overweight, they often experience fewer health complaints and illnesses. Local authorities and other non-medical organisations play an important role in this. Not all care needs require a medical solution. Care can be one solution, but so can help with poverty, support from peers, more exercise, or a combination of these. We must make the best possible use of the resources we have available, without wasting time, energy or money.
• Ensuring that people continue to work in the healthcare sector. That means ensuring job satisfaction, a safe working environment and the physical and mental well-being of staff. And less administrative red tape. We want to operate on the basis of trust rather than mistrust. People working in the healthcare sector must have the freedom to practise their profession.
• Sharing information as an essential prerequisite for good and safe care.
• We will roll out healthcare innovations that work well on a wide scale. And we will phase out healthcare that does not (or no longer) work.
• Digital healthcare. New technologies enable us to make better use of our (scarce) healthcare staff.
• We are committed to providing care that has as little negative impact as possible on the climate, the environment and the world we live in. This calls for green and climate-neutral care. We use raw materials sparingly and reuse them wherever possible.

In the Comprehensive Care Agreement, the signatories have reached agreements on these issues. The emphasis is on curative care, which is care aimed at helping people recover. However, we also take into account, for example, long-term care, local authorities and social work.

We want appropriate care and support for everyone. This means the following: :

• Appropriate care is demonstrably in the patient’s best interests. People, money and resources are put to good use.
• Appropriate care is provided with and centred on the patient.
• Appropriate care is the right care in the right place.
• Appropriate care is about health rather than illness.
• Appropriate care is provided in a pleasant working environment.

Choosing the right care requires major changes. These changes will not be completed within a few years. But we need to get started quickly, so we are beginning today. The changes require political decisions and clear agreements. The signatories have set out these agreements in a concrete work programme.

These are the items on the agenda:

1. Appropriate care

Providing appropriate care requires real change. We will work hard together to achieve this. Among other things, this change concerns what is and isn’t covered by health insurance. It is also about improving the quality of care: we want to provide only care that actually works. It is also about continuous learning and improvement, by both healthcare providers and patients. And it is about providing clear information to patients, so that they can choose the healthcare provider and treatment that best suits them.

2. Regional cooperation

To provide appropriate care, we must work together within the region: the right care in the right place. Regional stakeholders are drawing up plans setting out exactly how we will achieve this, in a way that is tailored to the region and the needs of patients. We agree to look beyond our own interests in this regard. We were already on the way to centralising healthcare. Close to home where possible, but for complex, specialised care, patients may need to go to a hospital that is a little further from home. This trend will accelerate even further.

We also want to improve our collaboration in emergency care. For example, we are making arrangements to ensure high-quality care that is always available in the evenings, at night and at weekends.

3. Strengthening local healthcare

People are living longer and staying in their own homes for longer, often with complex care needs. This places significant demands on local care services, such as GPs, physiotherapists and community nurses.

Vulnerable patients often have to deal with several healthcare providers. Through the ‘care close to home’ initiative, we aim to ensure that GPs have more time for each patient. We are also working to improve collaboration between the various healthcare providers in the neighbourhood. And we are going to make online healthcare easier and better. In this way, we are improving care for patients and making healthcare providers’ work easier and more enjoyable.

4. Cooperation between local authorities, GPs and mental health services (GGZ)

As more and more people need help with mental health issues, mental health services, GPs and local authorities are under considerable pressure. Due to waiting lists in mental health services, GPs are responsible for people with complex mental health needs for long periods of time. People with complex problems often have to wait far too long for the right care. This calls for a different approach to organising support: local, rapid, digital and, where possible, via self-help modules.

So that people can receive the right care and support sooner and waiting lists are reduced.

5. Healthy living and prevention

Health is about feeling well, both physically and mentally. And about playing an active part in society. A healthy lifestyle will need to become part of our daily lives. This is an ambitious goal, but we want to prevent people from becoming ill or their condition from worsening. Support for this comes first and foremost from the public or social sector. Preventive care funded under the Health Insurance Act is mainly provided to people who are ill or who are at increased risk of illness.

6. The labour market and support for people working in the care sector

The healthcare sector must be an attractive place to work and to continue working in. The sector is staffed by dedicated employees, but job satisfaction needs to improve. They look after us all. We, in turn, want to look after them properly. We therefore want to cut red tape. We want to improve staff development opportunities. We also want them to have a greater say in policy-making and to be given more time and scope for training. And more time to spend with patients. In addition, salaried employment must become more attractive.

7. Digitalisation and data exchange

The exchange of data is essential to achieving the objectives set out in the Integrated Care Agreement, and to providing high-quality and safe care. Electronic data exchange is the standard in healthcare. By 2025, all residents of the Netherlands will have digital access to their own healthcare data via a Personal Health Portal. In doing so, we pay close attention to privacy and data protection.

Appropriate care is also increasingly a combination of digital solutions and face-to-face visits to a healthcare provider. The guiding principles here are: do it yourself if possible, at home if possible, and digitally if possible.

8. Contracting

Competition ensures that health insurers secure the best contracts with providers, whilst paying close attention to price. This will remain the case. However, we will be looking at the process and the incentives involved in concluding these contracts. And providing appropriate care sometimes requires more equitable contracts.

Health insurers are set to keep a closer eye on the procurement of appropriate care.

For everyone

Through the commitments set out in this agreement, we are working together to shape the future of healthcare in the Netherlands. We realise that we must pull out all the stops. We are doing this for all those millions of (future) healthcare users and healthcare professionals in the Netherlands. In other words, for everyone. With this agreement, the parties pledge to commit themselves fully to this cause in the coming years.

Information about our region

The Netherlands is divided into IZA regions. The municipality of Apeldoorn forms part of the Apeldoorn/Zutphen IZA region. This region comprises the municipalities of Apeldoorn, Brummen, Epe, Hattem, Heerde, Lochem and Zutphen. This is complemented by residents, patients, service users, healthcare and welfare professionals, and the health insurer Zilveren Kruis. Together, we are working towards a healthy society with accessible and affordable healthcare. On the our region’s website outlines the steps we are taking together.