Positive Health Training Experience - A New Concept of Health from the Netherlands - ②
Makoto Kosaka, Orange Home-care Clinic
I have completed my initial training and now work at the Orange Home Care Clinic, specializing in home medical care. The purpose of my visit to the Netherlands was to learn about "Positive Health." Please refer to the first part of this article for more details on Positive Health. (https://www.mricg.info/single-post/positive-health-training-experience-a-new-concept-of-health-from-the-netherlands)
On the second day of the training, we visited "Snentz," a complex with a nursing home operated by ZOZ Healthcare Corporation, located in the town of Drachten in the Netherlands. Dr. Rufin, who guided us, emphasized that Snentz prioritizes fostering new interactions, describing it as having an atmosphere similar to a shopping center upon entering. The central gym and assembly space, with its high ceilings and skylights, are very bright. Adjacent to this area is a restaurant where elderly residents from the nursing home, which accommodates a total of 100 beds, and local elderly people mingle and dine together. There are also spaces such as a cooking studio primarily for men and an area dedicated to hosting a dementia cafe. Thanks to the generosity of a nearby museum, there is almost always an art exhibition on display.
At the beginning of the business presentation, there was an expressed sense of urgency that "we can no longer provide care as we have in the past," due to the increasing demand for elderly care associated with an aging population. Although over 2,000 healthcare professionals (doctors, nurses, physiotherapists, etc.) work across 14 locations, there are also more than 800 volunteers, and it was mentioned that "the role of volunteers will likely become even more significant."
In the Netherlands, the mainstream approach used to be placing individuals in facilities rapidly, but about ten years ago, the government shifted its policy towards home-based care, for reasons similar to those in Japan: reducing healthcare and caregiving costs. Similarly, the desire of citizens to spend their final moments at home aligns with sentiments in Japan. At Snentz, the first-floor area, previously part of the nursing facility, has been opened to the community to create spaces for the aforementioned interactions.
In response to the shortage of caregiving personnel, there is also a strong emphasis on implementing technology. Dr. Rufin introduced a dedicated watch for medication management, explaining that "caregivers can now focus on caring for the individual rather than managing medications." Furthermore, a machine that automatically dries the body after showering is currently under development. Both innovations focus on reducing the caregiving burden.
When asked how Japan is coping with its much more advanced aging population compared to the Netherlands, I felt that Japan is lagging behind. In the two months of home medical practice I observed in Japan, aside from electronic management of records, there seemed to be little technology implemented in caregiving facilities compared to the Netherlands.
A common challenge in both Japan and the Netherlands is the financial and human resource limits in healthcare. The Netherlands is trying to address these challenges through technology and volunteers, and a transition to home-based care, while seriously striving to reduce healthcare costs at ZOZ Healthcare Corporation.
Dutch healthcare distinctly separates primary care provided by family doctors from secondary care referred to specialists. Citizens are mandated to have private health insurance (approximately 200 euros/month), and this covers general practitioner visits without any additional costs. For family doctors, making home visits may feel inadequately compensated, but having healthier citizens is ultimately beneficial for primary care doctors. Decisions about secondary care (specialist consultations, hospitalizations) made by family doctors are exempt from charges above 350 euros.
ZOZ Healthcare Corporation has pioneered what is called "1.5-tier care." Specialists employed by hospitals visit local clinics regularly to offer consultations, keeping the primary care doctor as the main provider. These specialist visits at local clinics are counted as part of primary care, hence no extra costs to patients. Additionally, part of the care facility has been designated as "family doctor beds," allowing primary care physicians to provide near-hospital-level care. This system was established through negotiations with insurance companies and does not disadvantage the specialists financially, as they receive the same compensation for treatments as they would in hospitals. This arrangement benefits patients with no extra costs, saves on insurance payouts, and reduces the burden on family doctors. The only losers seem to be hospitals, yet ZOZ Healthcare Corporation's local outpatient services increased to over 2000 cases by 2023, reducing referrals to hospitals by 26% and cutting healthcare costs by 30%. "However, hospitals are somehow still managing to remain profitable," remarked Dr. Robert from ZOZ Healthcare Corporation.
The Dutch model could be a reference for addressing issues in Japan's rural areas, where there is a lack of manpower and financial resources. Relying on technology and volunteers might be necessary, although direct contract negotiations like those at ZOZ Healthcare Corporation might be challenging under Japan's universal health insurance system. However, new systems that improve medical efficiency could emerge.
Meanwhile, discussions in rural areas also focus on how to sustain hospitals. Positive reports are made when hospitals manage to maintain profitability by keeping up the number of inpatients. However, maintaining the number of inpatients amidst a declining population means an increasing proportion of the population is ill, a dilemma that has yet to be resolved even in the Netherlands.
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