the Department of Primary and Community Care, Radboud University, Nijmegen Medical Center, Nijmegen, The Netherlands; and the Dutch College of General Practitioners, Utrecht, The Netherlands.
This article analyzes Dutch experiences of health care reform-in particular in primary care-with emphasis on lessons for current United States healthcare reforms. Recent major innovations were the introduction of private insurance based on the principles of primary care-led healthcare and including all citizens irrespective of their financial, employment, or healthstatus; introduction of primary care collaboratives for out-of-hour services and chronic disease management; and primary careteam building, including practice nurses. These innovations were introduced on top of a strong primary care tradition of family practices with defined populations based on patient panels, practice-based research, evidence-based medicine, large-scale computerization, and strong primary carehealth informatics. Dutch healthreform redirected payment to support introduction of innovative health plans and strengthening of primary care to respond to public health objectives. Five recommendations for US primary care follow from this Dutch experience: (1) a private insurance model is compatible with thriving primary care, but it must include all people, especially the most vulnerable in society, and espouse a primary care-led healthcare system; (2) patient panels or practice lists strengthen continuity of care and community orientation to focus on and respond to local needs; (3) reward collaboration within primary care and between primary care, hospital care, and public health; (4) stimulate primary care professionals to exert their passion and expertise through participation in primary care research and development; and (5) health informatics should be primary care based, preferably adopting the International Classification of Primary Care. With these recommendations, it will be possible for the United States to obtain better population health for its population.