Dutch Orthopaedic Surgery Introduction of the country and the specialty

Dutch Orthopaedic Dutch Orthopaedic SurgerySurgery

Introduction of the country Introduction of the country and the specialtyand the specialty

The NetherlandsThe Netherlands

• On Saturday 13th of October: On Saturday 13th of October: 16.385.486 inhabitants, 484 / km216.385.486 inhabitants, 484 / km2

• Growing with average 80 persons per Growing with average 80 persons per day, birth 515, death 375, net day, birth 515, death 375, net immigration -75immigration -75

• Contact family doctor per year 75% - Contact family doctor per year 75% - 72%72%

• Contact specialist per year 37% - 40%Contact specialist per year 37% - 40%

2007-10-192007-10-19Frank van Oosterhout, UEMS, Frank van Oosterhout, UEMS,

Toulouse 2007Toulouse 2007 22



Age and mix of populationAge and mix of population

• ““Green demographic pressure” lowered Green demographic pressure” lowered from 68% to 40 % (ages 0 -20 / 20-65)from 68% to 40 % (ages 0 -20 / 20-65)

• ““Grey demographic pressure” rose Grey demographic pressure” rose from 14 % to 24 % (ages over 65 / 20-from 14 % to 24 % (ages over 65 / 20-65)65)

• Immigrants, “non Dutch”, all Immigrants, “non Dutch”, all generations, 3.170.406 is 19 % of the generations, 3.170.406 is 19 % of the population population



Number of HospitalsNumber of Hospitals

• 8 University Hospitals8 University Hospitals

• 88 General Hospitals88 General Hospitals

• 9 Specialised Hospitals9 Specialised Hospitals

• 51.000 hospital beds incl. day-care51.000 hospital beds incl. day-care

• 247.000 employees excl. private 247.000 employees excl. private practice medical specialistspractice medical specialists

• 7000 medical specialist in private 7000 medical specialist in private practicepractice



Risk ManagementRisk Management

• On 1st January 2008 all Dutch hospitals On 1st January 2008 all Dutch hospitals must have a risk management system, must have a risk management system, not only on medical risks but also on not only on medical risks but also on general risks for example fire risks, general risks for example fire risks, even financial risks and a system of even financial risks and a system of blame free reportingblame free reporting

• Corporate governance becomes for Corporate governance becomes for hospitals as usual as it is for companies hospitals as usual as it is for companies



Orthopaedic surgeryOrthopaedic surgery

• Dutch Orthopaedic AssociationDutch Orthopaedic Association• 770 members, 470 active surgeons, 3 770 members, 470 active surgeons, 3

non member orthopaedic surgeons.non member orthopaedic surgeons.• 3 general meetings each year, 2 of 3 general meetings each year, 2 of

two days and 1 of one daytwo days and 1 of one day• Main meeting every year in another Main meeting every year in another

city, main topic, sometimes together city, main topic, sometimes together with neurosurgeons, plastic surgeons with neurosurgeons, plastic surgeons or traumatologistsor traumatologists



Dutch Orthopaedic Ass. (1)Dutch Orthopaedic Ass. (1)

• DOA (NOV) is full member of the NOFDOA (NOV) is full member of the NOF

• DOA-BVOT meeting every two yearDOA-BVOT meeting every two year

• DOA full member of B&J DecadeDOA full member of B&J Decade

• DOA and subspecialty groups on DOA and subspecialty groups on traumatologytraumatology, pediatrics, implants, , pediatrics, implants, arthroscopyarthroscopy, , spinalspinal, foot - ankle and , foot - ankle and shoulder - elbowshoulder - elbow



Dutch Orthopaedic Ass. (2)Dutch Orthopaedic Ass. (2)

• Working groups on training and Working groups on training and educationeducation

• Working group on scientific workWorking group on scientific work

• Working group on disability evaluationWorking group on disability evaluation

• Working group on business aspectsWorking group on business aspects

• Working groups on patient education, Working groups on patient education, communication, website, professional communication, website, professional and product quality.and product quality.



Working EnvironmentWorking Environment

• Private practice 65 %, employee 32 %Private practice 65 %, employee 32 %

• General hosp. 46 %, training hosp. 29 General hosp. 46 %, training hosp. 29 %%

• University hosp. 18 %, University hosp. 18 %,

• One specialised hospital with 13 OSOne specialised hospital with 13 OS

• Several private clinicsSeveral private clinics

• 87 % calls itself fulltime with 52.2 as a 87 % calls itself fulltime with 52.2 as a mean number of working hours / week mean number of working hours / week



““Orthopaedic Performance”Orthopaedic Performance”

• 220.000 operations, 224.000 220.000 operations, 224.000 admissionsadmissions

• 34.500 meniscal excisions34.500 meniscal excisions

• 19.400 knee implants19.400 knee implants

• 22.400 total hip arthroplasties22.400 total hip arthroplasties

• 2.300 spondylodeses2.300 spondylodeses

• 10.600 intervertebral excisions 10.600 intervertebral excisions



Professional QualityProfessional Quality

• The D.O.A and its system of quality controlThe D.O.A and its system of quality control

• Peer to peer visits every five years, if Peer to peer visits every five years, if needed more frequentneeded more frequent

• Report of the visit is confidential, the Report of the visit is confidential, the result is notresult is not

• Quality visit is mandatory for continuation Quality visit is mandatory for continuation of individual registration as medical of individual registration as medical specialistspecialist



Product Quality (1)Product Quality (1)

• General Hospital Performance General Hospital Performance IndicatorsIndicators

• Indicators on system, process and few Indicators on system, process and few on outcomeon outcome

• For orthopaedic surgery: time For orthopaedic surgery: time between admission and operation in between admission and operation in hip fracture patientship fracture patients

• Also: systematic registration of Also: systematic registration of complicationscomplications



Product Quality (2)Product Quality (2)

• New indicators, especially on New indicators, especially on orthopaedic surgery, next year orthopaedic surgery, next year mandatorymandatory

• Insisted on by health insurance Insisted on by health insurance companies and patient organisationscompanies and patient organisations

• Complication registration, implant Complication registration, implant registration, DVT prophylaxis, infection registration, DVT prophylaxis, infection prophylaxis, patient education for hip prophylaxis, patient education for hip and knee surgeryand knee surgery



Implant RegistrationImplant Registration

• The Dutch Orthopaedic Implant register The Dutch Orthopaedic Implant register almost died ten years ago because of lack almost died ten years ago because of lack of financial airof financial air

• With the new DBC (=DRG look alike) With the new DBC (=DRG look alike) system resuscitation started, money system resuscitation started, money infusioninfusion

• This year, 11 hospitals start over with a This year, 11 hospitals start over with a new system, developed by the Leiden new system, developed by the Leiden University Orthopaedic ClinicUniversity Orthopaedic Clinic



Healthcare finance (1)Healthcare finance (1)

• All inhabitants have a health care All inhabitants have a health care insuranceinsurance

• There are seven insurance There are seven insurance companies in a competitive marketcompanies in a competitive market

• They all have to offer a basic They all have to offer a basic insurance package for a standardised insurance package for a standardised set of health care services, so they set of health care services, so they can only compete on price and can only compete on price and company service company service




• Private paractice orthopaedic surgeons are Private paractice orthopaedic surgeons are paid by fee for service in a DRG look alike paid by fee for service in a DRG look alike system, called DBCsystem, called DBC

• Hospitals are paid in a complicated budget Hospitals are paid in a complicated budget system based on historical out clinic, clinic system based on historical out clinic, clinic and day care production plus some other and day care production plus some other parametersparameters

• These two systems are not always These two systems are not always compliantcompliant




• Not only the insurance companies but also Not only the insurance companies but also the hospitals and medical specialists arrive the hospitals and medical specialists arrive in a competitive market with a government in a competitive market with a government disappearing to a background roledisappearing to a background role

• Within years hospitals will issue stocks and Within years hospitals will issue stocks and pay there investors, or will be bought and pay there investors, or will be bought and sold by investorssold by investors

• Will medical specialist become Will medical specialist become stockholders of the hospitals?stockholders of the hospitals?

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Dutch Orthopaedic Surgery Introduction of the country and the specialty