NETHERLANDS
Public — Ministry of Health Netherlands / Nederlandse Zorgautoriteit
Development and Implementation of the Dutch DRG System
PROJECT DETAILS
Case Study.pdf
CLIENT
Ministry of Health Netherlands / Nederlandse Zorgautoriteit
REGION
NETHERLANDS
YEAR
2006–2010
SERVICE AREAS
Funding & Reform
Governance
We were not brought in to consult.
We were brought in to build from the inside.
Dr Anna van Poucke · Founder, GHT
01
Situation
In 2002 a DRG system was introduced in the Netherlands that proved far too complicated — with over 30,000 DRGs, no uniform diagnosis classification, vulnerability to overcoding and significant administrative burden for providers. The system was fundamentally flawed and required complete redesign while maintaining stakeholder confidence and political support
02
Challenge
All stakeholder representatives wanted a fundamentally revised system but simultaneously resisted giving up their influence on its design — creating contradictory design criteria. The system needed to meet international standards while retaining Dutch-specific elements, within a tight government timeline.
03
Action
1
Programme transformation
Transformation of the maintenance organisation into a structural development, design and implementation organisation.
2
Stakeholder management & design criteria
Setting up international design criteria and aligning Ministry of Health and Dutch Health Authority through strong stakeholder management.
3
R&D lab
Setting up the R&D lab for the DRG system including diagnosis and activity classification, costing lab and time/material simulation lab.
4
Technology implementation
Management of technology implementation at provider and payor side, including political stakeholder management for decision and implementation process.
04
Result
New DRG system developed and accepted by all national stakeholder organisations — implemented and still the national reimbursement vehicle after 14 years
01
New DRG system based on ICD-10 and a single activity-based costing system developed and accepted by all stakeholders.
02
System implemented across all providers and payors nationwide.
03
Stable basis for Dutch healthcare costing for over 14 years with no major implementation issues.
04
System covers €22B in acute specialist care and €5B in mental health care
THE MODEL
A two-channel care model
Separating acute & complex care from elective care — so scarce workforce and infrastructure are deployed where they create the most capacity.
University Medical Centre
Acute & complex care
High acuity
Emergency
Specialist referral
Elective care
Planned
High volume
Day-case
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