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PubMed1994

Patterns of radiotherapy for cancer patients in south-eastern Netherlands, 1975-1989.

Radiotherapy patterns were determined in all 34,487 cancer patients diagnosed between 1975 and 1989 in south-eastern Netherlands, a densely populated and prosperous area with a greying population of almost 1 million inhabitants. Specialised care was available in 10 community hospitals with expanding staffs and in a non-academic radiotherapy centre, the distance never exceeding 50 km. With respect to western Europe the cancer incidence rates for this area were relatively high for males and average for females during this period. We computed overall and tumour-specific percentages of patients receiving radiotherapy as primary treatment (RT1a) and estimated this for initial treatment of recurrence or metastasis (RT1b). The total number of patients receiving RT1a increased by about 2% per year, but age-adjusted figures remained stable at 36% for females and increased from 28% to 32% for males. Since 1986 about 40% of all new cases receive RT1a and RT1b and about 40% of all RT1a undergo secondary radiotherapy for recurrence or metastasis. Of all male and female patients 70% and 50%, respectively, were over 60. Diverse underlying tumour-specific trends in RT1a were observed: children and adolescents with cancer received RT1a less often (25% vs. 40%) as did patients with cervical (55% vs. 80%), ovarian (9% vs. 17%), small cell lung (25% vs. 55%) and non-melanoma skin cancer (5% vs. 55%); patients with stage 1 breast (70% vs. 45%), rectal (30% vs. 10%) and prostate cancer (31% vs 13%) and adenocarcinoma of the lung (40% vs. 20%) received RT1a more often.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1985

Alcohol consumption and alcohol control policy: the case of the Netherlands.

In the last decades the Netherlands have experienced a strong increase in heavy drinking, alcohol-related morbidity and, to a lesser extent, alcohol-related mortality. Along with an increase in leisure time and income, it is possible that two more specific factors contributed to these developments in alcohol consumption, i.e. catching up with the drinking habits of neighbouring countries and a process of secularization. The strong increases mentioned have until recently not provoked any strong negative reactions, either from the public at large or from the government. Moreover, the Dutch government has no tradition in developing and implementing a restrictive alcohol policy. In two large-scale studies in Rotterdam and Limburg we have found that in the population at large, there are, with one exception, no strong sentiments in favor of or against concrete preventive measures. We argue that an effective prevention policy is necessary, which should at least contain the following elements: (1) a public health campaign to support the implementation of possible restrictive measures; (2) measures aimed at a stabilization or reduction of the per capita consumption; (3) specific preventive measures for high risk groups; and (4) a social and political structure which facilitates the formulation and implementation of a prevention policy.

Alcohol Drinking↗
PubMed1986

Lower referral rates for integrated health centres in The Netherlands.

The strengthening of primary health care is an important issue in health policy in The netherlands. The stimulation of co-operation and cohesion within primary health care and, in particular, the stimulation of integrated health centres is supposed to be an important mean to reduce the expansive growth of expenditures in the so-called second line (mainly medical specialists and hospitals). This article first describes recent trends in co-operation within primary health care and referral rates. For a better understanding of the issue in the context of the Dutch health care system we will also describe some of the rationale of the government policy to strengthen primary health care. In the second part results are presented of a study carried out to test if differences in referral rates among GPs in different practice settings can be explained by structural factors.

Family Practice↗
PubMed1987

Euthanasia, assistance to suicide and the law: developments in The Netherlands.

In this article the developments in euthanasia in The Netherlands are discussed. To a large extent unanimity has been reached about the definition of euthanasia. Since 1973 the courts have become involved in euthanasia cases. The lower courts and the Supreme Court allowed for euthanasia on request under certain conditions. In 1982 a State Committee on Euthanasia was established. This Committee made a proposal of a law on euthanasia and assistance to suicide on request. The Committee delineated requirements to be followed for euthanasia not to be punishable. Although a majority of the Dutch population is in favour of a liberalizing legislation, the political situation delays its adoption.

Euthanasia↗
PubMed1987

General and specific factors in the explanation of regional variation of hospital admission rates: policy consequences for Belgium and the Netherlands.

The analysis of regional variations in hospital admission rates for Belgium and the Netherlands shows that the available number of hospital beds together with the health status of the population (roughly indicated by age-adjusted mortality rates) are common factors to influence these admissions in spite of the fundamental differences between the health care systems of both countries. Further analysis shows that in Belgium the relative number of providers of ambulatory care (general practitioners, internists, paediatricians and gynaecologists) influences the residual admission coefficients negatively. Policy consequences of these findings are discussed. The recent adaptation of the Belgian Hospital Act that enables closure of existing hospitals for planning reasons is hailed with satisfaction. The importance of Roemer's Law--'a bed build is a bed filled'--is illustrated once again by this analysis.

Belgium↗
PubMed1989

Alcohol control policy in The Netherlands.

Alcohol consumption in The Netherlands tripled between 1960 and 1980. As a result, alcohol-related problems increased sharply. Therefore Dutch government in 1986 agreed upon a coherent alcohol control policy: more education, efficient treatment and new legislation. One of the first initiatives was the Alcohol Education Project. This consists of mass media campaigns, projects, public relations and research. Several campaigns have now been conducted. A survey was carried out into the reach and the effects after one year. The results look promising.

Alcoholic Beverages↗
PubMed1989

Local housing scheme and political preference as conditions for the results of a health centre-stimulating policy in The Netherlands.

About two decades ago, changes in the demand for primary care in the Netherlands resulted in a need for more interprofessional collaboration. Health centres developed as a new supply of integrated care. The government was aware of the importance of this phenomenon in its policy to strengthen primary care. The encouragement of health centres was a crucial part of it. The development of this policy and the resulting growth in the number of health centres will be reviewed here. In general, this growth is lagging behind initial policy expectations, partly because of a lack of instruments to implement PHC policy. Examination of geographical distribution of health centres, however, shows a variation suggesting that local factors also affect the development of health centres. Empirical findings show that the number of newly built houses in an area and the political 'colour' of the alderman for public health play a role in the development of health centres and thus co-determine the results of a central promotion policy to a certain extent.

Analysis of Variance↗
PubMed1989

The district concept for primary health care planning: attempts at implementation in The Netherlands.

Strengthening district-level primary health care systems has high priority in the WHO's 'Health for All' strategy. This article reviews governmental efforts to implement district health care systems in the Netherlands. Up to 1987, these activities corresponded to the WHO objectives, but their impact was limited. In 1987, government policy drifted away from these goals; the regulation of market forces and the increased influence of financing institutions have replaced planning by local government. Attempts to implement the district concept have, in fact, set primary health care planning back without offering the prospect of a leap forward.

Catchment Area, Health↗
PubMed1990

Orthotopic liver transplantation in The Netherlands. The results and impact of a medical technology assessment.

In 1985 Dutch health care authorities and health insurance companies initiated a large-scale technology assessment (TA) of liver transplantation (LTx) in The Netherlands. The 10-year experience of the existing programme in the University Hospital Groningen was investigated. Topics included were patient flow, selection policies, survival, quality-of-life, costs, need, supply of donor organs and organisational aspects. Estimation of the consequences of a non-transplantation scenario allowed for the execution of a cost-effectiveness analysis. Results showed clear improvement by LTx of survival and quality-of-life, though to a lesser degree than expected. Costs of the first transplantation year amounted to Dfl 180,000 (approx US $90,000). The cost-effectiveness ratio ranged from Dfl 47,000 to Dfl 133,000 per life year gained. No overt imbalance between need and donor supply existed or was expected in the near future. The impact of this study is related to the informational value and to the contribution to the decision-process. Even at its appearance in 1988, the final report provided health policy makers with new information. Health policy concerning LTx was considerably influenced, as a rule in agreement with the study conclusions. We conclude the Dutch case study to be an example of a useful and efficient TA.

Costs and Cost Analysis↗
PubMed1993

Evaluation of argon laser treatment of diabetic retinopathy and its diffusion in The Netherlands.

Argon laser treatment of diabetic retinopathy (DR) is the best evaluated case in the field of minimally invasive therapy. A well-organized randomized controlled trial was followed by formal cost-analyses and cost-effectiveness analyses. Laser treatment of DR proved to be cost-effective in a situation where there was no satisfactory treatment previously. Subsequently, screening strategies for retinopathy were developed. Systematic screening for DR in diabetic populations would be cost-saving from a societal perspective. The availability of effective and cost-effective therapy and cost-saving screening strategies for DR warrants active policy making to stimulate the implementation of strategies to control retinopathy in diabetic populations. Such strategies would ideally include both guided diffusion of argon lasers and the organization of screening programs. Data from the Netherlands are used to illustrate the diffusion of argon lasers in health care. After a slow start, argon lasers have diffused widely in the Dutch health care system. This development is complemented by recommendations for screening of the European diabetic population, which were issued in 1991. More active cooperation of all parties involved would benefit in preventing blindness from DR.

Argon↗
PubMed1995

Negotiating fees for medical specialists in The Netherlands.

This article presents an analysis of the negotiations on fees for medical specialists in the Netherlands since the introduction of the Law on Health Care Charges (WTG) in 1982. The peculiar position of the medical specialists and the institutional setting of the negotiations have produced a complex decision making process. Negotiations between the government and the health insurers on the one hand and the association of medical specialists on the other hand have been dominated by deep conflicts which were sometimes settled by temporary "peace contracts'. Attention is paid to the policy network, to the participants in the network and their principal goals, to the strategic use of the WTG by each participant and to the political effectiveness of the WTG. The article ends with a short overview of some recent developments and a sketch of three alternative scenarios on the future of the payment for specialist care.

Decision Making↗
PubMed1996

Home care policy in the Netherlands. Reforming legislation to facilitate the provision of multi-disciplinary home care.

In the Netherlands, it is considered necessary to provide multidisciplinary home care to meet the demands of a growing number of patients. Existing legislation must be changed to facilitate the provision of such care. Although this has been an important government policy goal for several years, it has been extremely difficult to fundamentally change legislation. This article presents an analysis of the Dutch system of decision-making on government policy, to explain why this is the case. Using theoretical concepts such as 'interdependence' and 'steering', the authors studied empirical data published by the Willems Subcommittee, a governmental advisory body.

Decision Making, Organizational↗
PubMed1986

Infection control in the Netherlands.

A survey was made by the Dutch association of infection control practitioners (VHIG) concerning the organization of infection control in Dutch hospitals and the activities of its members. The results are reported and compared with recent American studies. A comparison is made between a group of infection control technicians (ICTs) who were not nurses and a group of nurses (ICNs), working in infection control. Although the ICT has significantly more daily contacts with the hospital microbiologist and is more often secretary to the infection control committee and the ICN visits the outpatient department significantly more often, the other activities in their practice are essentially the same. From this study we conclude that either an ICT or an ICN can adequately function as an infection control practitioner in the Netherlands.

Adult↗
PubMed1991

Growth and equity effects of changing demographic structures in the Netherlands: simulations within a social accounting matrix.

"This paper deals with the economic consequences of a changing demography in an industrialized country, namely the Netherlands. The analytical framework chosen is that of general equilibrium as statistically given by the social accounting matrix (SAM) in which we introduce households by size for the present economic demographic situation (1981) and for a future simulated situation (2010) featuring in particular a relative increase in one-person households (individualization). The income (output) multipliers of both SAMs show a positive growth bias towards three and more person households and towards mining, public utilities, trade and banking."

Demography↗
PubMed1983

Licensing of psychoactive drugs in the Netherlands.

The Dutch Board for the Evaluation of Medicines approves applications for a marketing authorization if on the basis of pharmaceutical, pharmacological--toxicological, and clinical data the benefit--risk balance is considered positive. In the Netherlands, almost 4000 drugs have a marketing authorization, 145 of these belonging to the psychotropic drugs. During the Board's existence the number of applications and the number of approvals for antipsychotics and antidepressants decreased, while an increasing amount of anxiolytics was applied for and approved. This phenomenon may reflect the prescribing behavior of doctors. The Board has on several occasions actively influenced the market situation of certain drugs, e.g., amphetamines have almost totally disappeared from the market since a strong restriction of the indications was imposed. A certain shift in the evaluation policy of the Board can be noticed in some respects, for instance, data on chronic use are no longer required for registration of hypnotics. The requirements for registration of antidepressants are less strict than in the past. The Board tries by its registration policy to be an objective interface between the drug-producing companies and the consumer, the patient, and seeks the highest standards possible in the drug market.

Drug and Narcotic Control↗
PubMed1989

The familial dysplastic nevus syndrome. Natural history and the impact of screening on prognosis. A study of nine families in the Netherlands.

Since 1982, nine families with the dysplastic nevus syndrome have been identified in the Leiden area (The Netherlands). A total of 50 primary melanomas were diagnosed in 38 persons. Nineteen of these melanomas had been diagnosed before the start of the screening programme (category I), 11 were detected at the initial examination of the families (category II), and 20 were found during the course of follow-up (category III). To assess the effect of screening, we compared these categories with respect to the developmental stage of the melanomas. One of the 19 melanomas in category I, two of the 11 in category II and seven of the 20 in category III were melanoma in situ. The average thickness of the invasive melanomas in categories I, II and III was 1.75, 0.80 and 0.54 mm respectively. Sixteen of the 19 melanomas in category I (84%) were Clark III or IV, whereas 15 of the 20 melanomas in category III (75%) were Clark I or II. From these findings it may be concluded that screening can lead to the detection of melanomas at an earlier stage, which in turn can permit curative treatment and improvement of both prognosis and life expectancy. The need for supervision based on central registration of affected families to guarantee the continuity of screening is discussed.

Adolescent↗
PubMed1989

Cancer in The Netherlands. From scenarios to health policy.

Future scenarios on cancer in The Netherlands were made with the help of existing trends, demographic changes and expected developments in cancer research, prevention, screening and treatment. Until the year 2000, cancer incidence will probably increase by 1.5% per year, by nearly 3% per year and the need for health care facilities accordingly. Upon the request of Parliament, the Dutch government used this information to formulate a long-term cancer control policy. Faced with a restricted budget and a growing demand for care, the government plans to increase its efforts in the areas of prevention and screening and to improve the efficiency of cancer care. More attention will be paid to the quality of life of those patients who cannot be cured. Support for cancer research will be maintained at its present level.

Female↗
PubMed1983

Health policy and health services research in The Netherlands.

This paper describes the development of health services research in The Netherlands in the last decade. For that purpose, an outline of the organisational structure of health research in general is presented first. It is shown that an increasing share of total resources for health research is allocated to health services research, now amounting to almost 10%. Emphasis is on the development of government health policy, which has given a strong stimulus to the volume of research projects in this area. Preparatory to the introduction of the new Health Care Services Act, which introduces the concept of planning of all health services at decentralised level, a large research program is being developed by the Ministry of Health and Environmental Protection. This program includes activities such as the development of regional health information systems, studies on the coherence of health care facilities, studies on efficient resource allocation and studies related to quality assessment and effectiveness of health care provision. Furthermore, a number of governmental policies to support the development of health services research are considered. Most important in this respect is the development of a Council for Health Research, which advises the government on all issues of research policy and which constitutes of scientists, government representatives and representatives of organisations using research work. Finally, an attempt is made to describe the Dutch situation within the international context.

Health Policy↗