Chronische zorg in Nederland anno 2010: leidt verandering tot verbetering?

Care for chronic patients is subject to transformation in many countries. This paper discusses recent transformations of chronic care in the Netherlands to answer the question: to what extent do these changes result in improvements? Important policy measures of the Ministry of Health, Welfare and Sports to improve chronic care are a programmatic approach for the organisation of care by means of so called standards of care, and integral financing of chronic care by means of diagnosis treatment combinations. In daily practice, both policy measures are implemented on the level of health problems like diabetes and vascular risk management. Notwithstanding the adequacy of the approach to improve chronic care in the Netherlands, its impact is unclear. It is argued that the policy measures need to be implemented on the level of patients. For this to happen, two recommendations are suggested: to make use of the building blocks of the chronic care model in an integrated fashion and aimed at the needs of patients, and to evaluate care transformations not in isolation and by making use of adequate performance indicators.

Keywords: chronic care, health policy, chronic care model, quality improvement, patient