Summary

Health Care all over the western world seems to suffer of a disease of growing costs and decreasing quality. The Minister of Health in the Netherlands, Hans Hoogervorst, has introduced a cure that seems to be controversial to politicians in the Netherlands, but is perceived by a majority of parties active in the business of health care, as the last possible cure to the system: market competition. Different and several professionals have been wondering how new systems of health care (meaning cure and care) can turn the tide into better care for lower costs. Three promising models have been forwarded: ‘Integrated care’, (a school of thought concentrated around ‘the international journal of integrated care’), ‘consumer driven health care’ forwarded and advocated by Regina Herzlinger, and the thoughts of Michael Porter and Elisabeth Olmsted Teisberg concerning ‘Value based competition on results’ so as to redefine health care. Furthermore, new developments of marketing thoughts concerning ‘customer value’ are a stimulating idea concerning the improvement of patient choice and the interaction between patient and care professionals in the process of care ‘delivery’. My idea for this study was to explore the possibility to construe a conceptual model that could integrate the most promising aspects of the different thoughts into one cohesive set of principles and characteristics for the delivery of health care. This conceptual model should have the promise that, when adopted and implemented, it could really do the trick: improve quality of care and lower costs. I named it: ‘Value driven Health care – Een model voor waardevolle zorg voor gezondheid’. The three afore mentioned models can be seen as three models that add up to each other: the integrated care model, being the core one of the three in proclaiming the relevance of focused coordination of all activities, information and systems to a specific disease or cause for care and designing these in one effective and efficient program. Next, the school of consumer driven health care that puts the patient into the centre for choice of financial arrangements and care itself. And, finally, the idea of value based competition that proclaims a system and structure for care delivery that puts the results of care as the dominant focus for delivery, efficiency and choice of care at the centre. Next, I summarize the results of the interviews I conducted with relevant representatives of the different parties involved with the development of the Dutch health care system to check whether the ideas of the constructed model would be valid to them and whether they would see the model as a guideline to the different parties active in health care. They are representatives of patient and consumer associations, health care insurers, the chair of the board of a large hospital and a representative of the national Dutch Health Care Authority (‘NZA’). They indeed agreed on the content of the model as stating the ‘communis opinio’ on the subject. In the discussion section I put forward a model of the ‘Health Care Transaction’. The model integrates three perspectives on care delivery: • The structure and process of care as seen from the professionals and institutions for care delivery, aiming to adhere to professional values for care to optimize the value of ‘Quality of

Life’; • The perspective of client experience, delineating customer value and other aspects of customer perception but also actions, responsibilities, rights and duties that are relevant or even conditional to adequate care for Quality of Life from the patient perspective; • The ‘business’ perspective of it all referring to the way in which the process is designed, programmed, organised, financed and otherwise arranged to make it efficient, effective and worthwhile in view of economic value.