Improving efficiency in the Dutch health care system: current innovations and future options

In recent years a variety of efforts have been launched in the Netherlands that are explicitly concerned with more effective use of limited resources. Among these innovations are improved systems for the monitoring of utilization and cost of medical care providers, demonstrations of incentives for cost-effective care, the development of community care projects, and efforts to improve coordination of care. Further experimentation is proposed, using the selective adoption of techniques developed by limited provider plans (HMOs and PPOs) in the United States. While these efforts can provide specific examples for health care organizations in Europe, there are broader lessons for managers and policy makers from this review. These lessons are that managers must have the freedom and discretion to develop new ideas and approaches; successful change must involve new cooperative relationships among providers and financial bodies; and that there are many alternative configurations and modifications, contingent on the local environment. This leads to the final conclusion that local experimentation is essential to successful innovation.