Integrating Care through Bundled Payments — Lessons from the Netherlands

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Abstract
In industrialized countries, the number of people with chronic diseases continues to increase, putting tremendous pressure on health care systems. At the same time, there is a growing need for more patient-centered care.1 Various approaches to addressing these challenges have been introduced, including, in the United States, the concept of the accountable care organization (ACO) — a vehicle for implementing comprehensive payment reform and redesign of the health care system in an effort to control growth in health care costs and improve value.2-4 In the Netherlands, numerous initiatives were introduced to enhance the quality and continuity of care for chronic diseases, but their fragmentary funding hampered the establishment of long-term programs. In 2007, the Dutch minister of health therefore approved the introduction of a bundled-payment approach for integrated chronic care, initially on an experimental basis with a focus on diabetes. In 2010, the bundled-payment concept was approved for nationwide implementation for diabetes, chronic obstructive pulmonary disease (COPD), and vascular risk management.

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