The reform of hospital care in the Netherlands

OBJECTIVES. This article provides a short overview of the structure of hospital care in the Netherlands. It discusses a number of hospital reform programs that have been started since the early 1980s and others more recently proposed. Attention has also been given to the potential impact of hospital reform. METHODS. Descriptions of hospital structure, planning, financing, payment of medical specialists, and hospital workforce and services provide a context for a discussion of current hospital reform programs. Trends in hospital care delivery, strategic management and internal organization are examined. RESULTS. The relationships between the hospital and other health-care providers, health insurers, employers, and patients are found to have a significant impact on the future of the hospital. The interconnections of these four factors will help form the basis for an understanding of ongoing hospital change. CONCLUSIONS. Hospital care has been subject to rapid change during the last two decades, as hospitals become centers for acute specialized medical care. This development has important consequences for the position of hospitals in the health-care delivery network, as they become one of a number of providers in a more integrated delivery system. It should be noted that the changes in hospital care cannot be understood as the results of a single reform program but rather as the result of a long series of reform efforts.