PubMed · 10178115
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H P Dooskin. 1998. Strength in unity.. https://pubmed.ncbi.nlm.nih.gov/10178115/
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This article reviews the start of the use of targets as a tool in health policy, summarises the fruitful uses and frequently-heard objections, and proposes some conditions for successful health target setting. Targets as tool in health policy are based on the 'management by objectives' approach (1954). The use in health policy was possible due to advances in the use of epidemiology for public health purposes. It provisionally ends with the new health targets adopted by WHO in 1998. The setting and monitoring of health targets is one way in which a government can provide leadership, guidance and strategic direction for the health sector. These benefits, and others, will also be reviewed. Drawbacks - such as political accountability and the limited malleability of society - will also be discussed. To overcome most of the objections, the article ends with some SMART conditions for successful health target setting: specific, measurable, achievable, realistic and time-bound. When SMART conditions are met, political will and daring are the recipe for a successful health target approach.
The use of health targets as a tool in health policy is receiving more attention. Beyond political will and daring, there awaits the challenge of the fruitful use of health targets. This means an adequate response to the complexity of population health in a target structure that is transparent, controllable, and adaptable in changing circumstances. In this article, we will review the health policy development cycle in relation to health target setting. First, there should be understanding of the problem, and a clear picture of the health status of the population. Then a solution can be chosen. This part is not restricted to the technical side of the solution, i.e. the target setting and action planning. It also has a political side in which responsibility is taken for the choices made. In the next step, the chosen solutions are implemented by government and stakeholders. This will be followed by a monitoring and evaluation phase, which will in turn provide us with an insight into the health status of the population. At every stage of the health policy cycle, questions which should be addressed when using health targets in health policy will be discussed.
The Dutch healthcare system is not a single overall plan, but has evolved from a constantly changing mix of institutions, regulations, and responsibilities. The resulting system provides high-quality care with reasonable efficiency and equal distribution over the population. Every Dutch citizen is entitled to health care. Health insurance is provided by a mix of compulsory national insurance and public and private insurance schemes. Hospitals generally have a private legal basis but are heavily regulated. Supraregional planning of high-tech medical services is also regulated. Hospitals function under fixed, prospective budgets with regulation of capital investments. Independent general practitioners serve a gatekeeper role for specialist and hospital services and are paid by capitation or fee for service. Specialists are paid by fee for service. All physicians' fees are controlled by the Ministry of Economic Affairs. Coverage of benefits is an important method of controlling the cost of services. There is increasing concern about health care quality. Health technology assessment (HTA) has become increasingly visible during the last 15 years. A special national fund for HTA, set up in 1988, has led to many formal and informal changes. HTA has evolved from a research activity into policy research for improving health care on the national level. In 1993 the government stated formally that enhancing effectiveness in health care was one of its prime targets and that HTA would be a prime tool for this purpose. The most important current issue is coordination of HTA activities, which is now undertaken by a new platform representing the important actors in health care and HTA.