Page 185 - ES 2020-21_Volume-1-2 [28-01-21]

168 Economic Survey 2020-21 Volume 1

Netherlands The Dutch government National-level regulation The Dutch regulatory
has defined quality provides for the overall framework uses a mixture of
of care in terms of requirements for quality of policy instruments to safeguard
effectiveness (clinical care to be defined further the quality and safety of
effectiveness; patient by professional bodies healthcare. The system relies
safety), patient- on how to meet these to a great extent on self-
centeredness and requirements in a way that regulation and voluntarism,
cost-efficiency, which safeguards quality and through for example having
form the basis of the delivers ‘responsible care’ the medical profession define
regulatory system and (verantwoorde zorg). For ‘verantwoorde zorg’, develop
national regulation. example, the 1996 Quality clinical guidelines and medical
Act makes quality systems training programmes, and
mandatory for all healthcare having a voluntary system of
institutions (excluding external accreditation. Hout
GPs and dentists), further et al. (2010) argued, that the
stipulating that healthcare Dutch supervisory regime is
institutions have to provide characterized by comparatively
‘responsible care’ (defined low formal intervention rates, of
as care being of a good around 10–15 per cent. This may
level, suitable, patient- and be because of the time required
needs-oriented); to provide to work through cases and the
a structure that allows for potential risk of creating mistrust
the delivery of responsible and frustration among actors in
care and communicate how the healthcare sector. Friele et al.
they achieve/maintain it; (2009) reviewed the regulatory
to systematically monitor, instruments of the 2006 Health
control and improve Care Market Regulation Act
quality of care; to publish (Wmg) and noted that the Dutch
annual reports on quality Health Care Authority (NZa)
management and quality appears to opt for acting in a
delivered. less interventionist way. The
fragmented system of healthcare
governance at central level for
the cure and care sectors,
and decentralized governance
responsibilities for social care
and public health, can be seen to
increase the risk for inequity in
healthcare provision.