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Recognising the connections

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The Dutch Ministry of Health, Welfare and Sports (HWS) (www.vws.nl/en) has become increasingly aware of the value of medical technology and innovation. This is not only in terms of the improved medical care it provides, but also the more efficient health care. In a recently issued letter titled “Clever Investment in Health Care,” the HWS talks about “investment” and “prevention and innovation.”¹ The response to this by Nefemed, the trade association for the Dutch medical technology industry, is that more needs be done to introduce innovative products into the health care system. As well as a focus on introduction, much more attention will have to be paid to sharing cost-effectiveness studies that demonstrate the foundations of cost or labour savings in the supply chain.

Focussing on quality of care

Improving the quality of health care is closely connected to innovation. It is pleasing that quality of health care is increasingly being recognised as an underestimated element in the reform of the system where, currently, the emphasis is on lower prices and the cost of care, whether inpatient, outpatient or home care.

The Council for Public Health and Health Care (RVZ) has published a report titled “Health Care Purchase.”² The report addresses the way in which care will have to be purchased in the future. It states that care should be purchased selectively with a focus on quality. Health insurers, together with patients’ organisations will have to determine beforehand the agreements that should be made to purchase care. Care that is of insufficient quality should no longer be contracted. According to RVZ, the selective purchase of care based on the quality of the care will contribute to combating the substantial growth in care expenditure. Health insurers will have to achieve this by introducing more professionalism into purchasing policy and this involves making a considerable investment in their own expertise. It also means that health insurers will need to work together with patients and reach robust agreements with care providers. This will result in customer and quality orientation in the care supply chain and the role of patients’ organisations will be strengthened. Nefemed welcomes this reform. In addition, a report on sustainable expenditure management (cost containment in health care) is due to be published. HWS will respond to both reports by the end of 2008.

Saving labour costs

The issue of labour saving medical technology has gained in importance because of increasing shortages of personnel in health care. Medical technology and innovation are part of the solution. STG/HMF, a health care network organisation, recently published a report with input from Nefemed that was presented to HWS: “Room For Laboursaving Technology to Ensure Sufficient Care in 2025.”³ The most important message in this report is that in 2025 there will either be complete nursing and care available for dementia and coronary disease patients and little care available for the rest of the population; or insufficient care for that patient group in 2025 to make available a low level of care for the total population. Both these scenarios need to be avoided. In the report, labour saving technology is taken as a means to offset the care shortage. This technology will have to be introduced on both sides: the patient side (preventing care requests) and the nursing and care side (improving work processes). All labour saving technology will have to yield benefits to all patients for whom this technology is developed within a five year period.

Nefemed will promote the labour saving aspects of medical devices and technology in the heath care process. The report provides an example concerning the contribution that the purchase of a different kind of incontinence underwear can yield for patients in a nursing home. Use of this underwear results in less frequent changing of underwear, which means less “hands on care” (hours) and in turn substantial savings on personnel costs, calculated at more than 10 per cent. These hours can then be utilised in other, more useful ways.

Paying for innovative products

Compensation for, or inclusion of, new innovative products or technologies in a basic health insurance package is another important issue. An innovation office is being set up by the Health Care Insurance Board, CVZ (www.cvz.nl), and ZonMW, a health research and development organisation (www.zonmw.nl/en). The office will support innovations with temporary financing and/or subsidies from regulations that are already in place in The Netherlands. The industry needs a solution oriented innovation office for medical technologies. It is awaiting events, together with other interested parties, concerning this initiative because the regulations for medical technology have not yet been clearly formulated.

Hospital financing and performance related funding is based on DBC, which is the Dutch version of the diagnosis related group reimbursement model. However, this system provides too little insight for it to be used as a negotiation tool between hospitals and health insurance companies. Medical devices are included in DBC, but are barely visible. The setting up of new DBCs or adapting existing technologies to new and/or more expensive technologies has been proposed, but is bureaucratically unclear. Nefemed is seeking to clarify the position of medical technology in the DBC system and in the regulations of new DBCs. In the opinion of the Association, the current pace of development of new DBCs is much too slow, and the system includes hardly any medical technology innovation. Therefore, it advocates a rapid introduction of flexible DBCs, solely for implementation of new technologies.

In 2007, the role of CVZ changed. It advises the minister on what the health insurance package should contain and what should be covered by the health insurers. In 2007 and 2008, CVZ formulated recommendations on what should be included and excluded in the basic health insurance package. Preceding the advice, a number of parties in the field are consulted. This year for the first time Nefemed was one of the consulted parties and therefore gained insight into the issues at an early stage. This has enabled the Association to take an active position with regard to including technologies in the package to be compensated. For 2008, this has resulted in the start of discussions on the way in which innovative medical devices should be covered. Nefemed will continue to work hard to influence the decision-making of the CVZ and the HWS, which will affect the health care system in 2009.

Information supplied by Nefemed, the Dutch federation of manufacturers, importers and distributors of medical products, Reitplein 1, NL-037 AA Tilburg, The Netherlands, tel. +31 13 5944 342, e-mail: nefemed@wispa.nl, www.nefemed.nl.