Primary care and home care scenarios, 1990-2005 : scenario report commissioned by the Steering Committee on Future Health Scenarios

CARE AT HOME -HOME CARE Health care in the Netherlands looks to be a well structured system. Supplementing the vital level of self-care and informal care are four levels of professional care: the public health service (known in the Netherlands as basic health care) is mainly concerned with preventive work aimed at the population at large; individuals with problems can contact their general practitioner or other primary care provider, who can -depending on the problem -refer them to specialists in the cure-oriented and hospital-centred secondary sector; where necessary, patients can then be referred on to the institutions of the tertiary sector with their role in mainly long-term care. On paper this pyramidal structure appears to work well; in practice, and in particular where complex forms of care are involved, the boundaries become blurred. Medical advances and social and economic developments may delay death to ever greater ages, but disease is not defeated; and since the risk of developing chronic conditions rises with age, more and more people become incapacitated and those who do remain so for longer. This leads to a growing demand for care and compels us to reconsider patterns of provision. The need for such reconsideration is reinforced by users' changing needs and aspirations, as patients increasingly wish to be nursed and cared for in their own surroundings if at all possible. Technological advances mean that wish can often be accommodated.

This report focuses on the organization of primary and home care in the future. Realistic possibilities are outlined in scenario form, with positive and negative aspects being brought out in each case. Together with expected trends in health and sickness the report charts the developing pattern of care needs and consumption. The prospects for home care are examined notably in relation to complex medical conditions and patients with multiple pathology. The essential conditions for home care are presented, linked to various categories of patients. These extramural network, extramural centre, transmural network and deconstruction scenarios represent different approaches to the organization of care delivery. Interested parties can flesh out the most desirable situation from their point of view. Possible ways of putting the various approaches into practice are indicated in this report. Preceding the scenario report proper is an outline of the structure of the Dutch health care system.

Front Matter....Pages i-xiii Summary....Pages 1-18 Introduction....Pages 19-20 Dutch health care in the European context....Pages 21-43 Social trends and home care....Pages 45-70 Caring for people at home....Pages 71-97 Study design and methodology....Pages 99-110 Care consumption: trends and estimates....Pages 111-140 Complex home care....Pages 141-163 Towards scenarios for the future organization of primary and home care....Pages 165-191 The scenarios: assessment and synthesis....Pages 193-225 Back Matter....Pages 227-253