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D M Delnoij

Publications and source records attributed to D M Delnoij.

3 recordsLinked to original sources
PubMed2004

Developing a national performance indicator framework for the Dutch health system.

OBJECTIVE: To report on the first phase of the development of a national performance indicator framework for the Dutch health system. METHODS: In January 2002, we initiated an informed interactive process with the intended users-policymakers at the Ministry of Health, Welfare and Sport-and academics to develop both the conceptual framework and its content. Decisions were based on consensus after discussing strategic goals of the health system, information needs of policy makers at the Ministry of Health, Welfare and Sport, and studying existing theory and international experiences with national performance indicator frameworks. We identified objectives and criteria for a framework at the national level, constructed a conceptual model, and selected indicator areas. RESULTS: As a starting point we chose a balanced scorecard reflecting four perspectives towards health system management information at the national level. These perspectives are consumer orientation, finances, delivery of high quality care, and the ability to learn and grow. We then linked the Lalonde model for population health to a balanced scorecard model. The constructed model makes the relationship between population health and health system management apparent, and facilitates the presentation of performance information from various perspectives. The model reflects the strategic goals of the Dutch health system, i.e. contributing to the production of health by providing necessary health care of good quality that is accessible for all Dutch citizens while simultaneously informing policy makers about the performance of the entire health system in all sectors (care, cure, prevention, and social services). The selected indicator areas for health system management information (20 in total) reflect the policy and management functions of the government and the defined public goals of the health system. The model was formally adopted by the Ministry of Health, Welfare and Sport in February 2003, and since then individual indicator areas have been operationalized by 30 representatives of various departments at the Ministry with continuous external research support. CONCLUSION: The merit of linking the balanced scorecard inspired model to public health data is that it facilitates the visualization of the contribution of the health system to the improvement of population health. The method of an intensive interactive indicator development process between policy makers and researchers has so far proven successful.

Delivery of Health Care↗
PubMed2000

All rights reserved, or can we just copy? Cost sharing arrangements and characteristics of health care systems.

In most European countries cost sharing has been introduced in order to reduce the demand for care. Different forms of cost sharing are available, but because of historically grown system characteristics and prevailing values countries differ in the application of specific forms. This review focuses on eighteen European countries, and on the combinations of health system characteristics and present forms of cost sharing. We found that some combinations are more present: different payment systems for primary care physicians go together with different forms of cost sharing, different services have different forms of cost sharing. In countries with a GP as gatekeeper no charges are in use for the GP. No distinct relationship could be found between the financing system (tax-based or insurance-based) and the form of cost sharing or the exclusion of vulnerable populations. It is concluded that there are two ways of filtering 'unnecessary' demand. One is by introducing cost sharing for directly accessible services such as GPs. The second way is by having GPs act as gatekeepers to more specialized, and more costly care.

Cost Sharing↗