Payment for medical care should be linked to outcomes that patients value, meeting concludes

BMJ 2012; 345 doi: (Published 11 September 2012) Cite this as: BMJ 2012;345:e6104
  1. Tessa Richards
  1. 1Nijmegen, Netherlands

Rapidly rising spending on healthcare in the Netherlands has not been shown to bring added benefit to patients, a meeting in Nijmegen, organised by the Scientific Institute for Quality of Healthcare, was told last week.

Dutch healthcare costs have been rising at 7% a year, and hospital expenditure has doubled since 2000, said Gert Westert, director of the institute. But quality of care varies across the country, and the effect on health outcomes of greater use of diagnostic tests and interventions, which differ markedly between regions, is not known, he said. “Outcomes are not systematically logged and fed back to providers; healthcare is a volume industry not a value one.”

Drawing on data collected by the Dutch Atlas of Healthcare Variation (, he cited treatment for gallstones as an example. Cholecystectomy rates vary between 50 and 250 per 100 000 …

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