In collaboration with the City of Amsterdam and NIVEL (Netherlands Institute for Health Services Research), ahti is researching the extent to which use of primary care services correlates to the use of social domain care services in the City of Amsterdam. The reform of the Dutch healthcare system in 2015 resulted in a redistribution of responsibilities, which had a negative impact on interrelationships amongst care domains. By using data to map out such interrelationships, it is possible to support care policy at the local level and to monitor and evaluate policy effects. Ahti is combining data on primary care (NIVEL care records and Vektis care cost data) with municipal data on Social Support Act care in Amsterdam, supplemented by socioeconomic data on the local population (Statistics Netherlands data). The project also aims to test whether the adopted methodology is effective in practice. Together with NIVEL, ahti is responsible both for the management of the project and for the research it involves. The project is due to end in 2020.

System reform: transfer of care responsibilities from central government to municipalities

Since the transfer of responsibility for some care services from the central government to the municipalities in 2015 (the ‘system reform’), there have been three systems for funding and managing care services:

1. The municipalities are responsible for the care and support of people living independently, under the Social Support Act (‘Wmo’).
2. Under the Long-term Care Act (‘Wlz’), the central government is responsible for people who need 24-hour care at home or in an institution.
3. Health insurers reimburse care that falls under the health insurance package through the system created by the Health Insurance Act.

One of the ideas behind the system reform was that municipal governments are closer to their citizens, enabling them to organise more efficient and effective care. Therefore, giving greater responsibility to municipalities should drive care costs down and the quality of care up.

System reform brings new challenges

The transfer of care responsibilities from central government to the municipalities in 2015 has also had the effect of increasing the importance of the primary care sector, as people continue living at home for longer and certain forms of specialist care have been transferred to the primary sector. That raises the question: to what extent is primary care use linked to the use of care in the social domain? Answering that question can provide insight into the quality and accessibility of care in both domains. It is reasonable to assume that changes in the social domain affect primary care, and vice versa.

The number of people in Amsterdam receiving Wmo support has risen from 47,500 (2017) to ~51,000 (2018) [source: City of Amsterdam Annual Report 2018]. The cost of providing Wmo support has also risen since 2017. The cost of implementing the new Social Support Act has reached €99.2 million, about €12.3 million over budget.

Ahti combines datasets to deliver valuable insight

Ahti has combined data on primary care (NIVEL care records and Vektis care cost data) with municipal data on Social Support Act care in Amsterdam, supplemented by socioeconomic data on the local population (Statistics Netherlands data). The following points were taken into account:

• Whether the two datasets could be linked in the Statistics Netherlands remote access environment
• Whether the people included in the NIVEL data were representative of the Amsterdam population as a whole
• How care use in the two domains was linked and what the relationship implied

We have realised the first two goals and the first analyses yielded significant insight. For example, people in Amsterdam who are receiving Wmo support do indeed also make more use of primary care services than people who are not. Further analysis of these forms of care use over time can lead to a better understanding of the factors that influence their relationship. GPs could, for example, become more involved in the Wmo support process.

Status of the NIVEL project

One of the first conclusions of this project is that the combination of NIVEL data and Statistics Netherlands data does indeed yield a representative picture and can provide valuable insight. We have combined data from NIVEL and the City of Amsterdam in the Statistics Netherlands environment, and the results of the project have since been presented to the City of Amsterdam.

Partners

• City of Amsterdam
• NIVEL (Netherlands Institute for Health Services Research)
• Statistics Netherlands (CBS)

Contact

More information or do you have a question? Please contact Rachel van Beem (Head of Projects).