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De kloof overbrugd? : een beschouwing van zorg-op-afstand vanuit vier perspectieven

Vulto, Martijn (2009) De kloof overbrugd? : een beschouwing van zorg-op-afstand vanuit vier perspectieven.

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Abstract:As a result of an ageing population the Dutch health care system is facing a growing gap between supply and demand of care. This leads to an annual increase in health care expenditure. A substantial share of that expenditure comes from care for the chronically ill. This report demonstrates to what degree remote care, i.e. the use of technology to shift part of the health care process to the patient’s home, can contribute to solving the capacity problem of the Dutch health care system. To achieve this, the issue has been considered from four perspectives: specification, business model, implementation and diffusion. In is in principle possible to generate economic benefits with certain specifications of remote care. Academic literature reports cases of cost reductions through shorter travelling times, reduced face-to-face contact and fewer hospitalizations. However, these findings do not lend themselves for generalization. Two Dutch case studies have shown potential but no actual cost reductions. Remote care yields the greatest benefits for a select group of home care clients who live far away from the nearest clinic or who make excessive use of home care services. Additional savings are possible if complications in (co-morbid) diabetes patients can be prevented, if teleguidance can be substituted for coaching of CHF patients and if CHF patients can sooner be released from the hospital because of the availability of telemonitoring. Development of inexpensive technologies will further contribute to the cost-effectiveness of remote care. The offering of remote care services typically requires a technical infrastructure, an interface, a database, content and in some cases measuring equipment and a medical call center. Suppliers of these resources need to stand something to gain from their efforts. This requires a well-functioning business model. A difficulty that presents itself is that most revenues from providing remote care initially flow to the care providing institution. Precisely those institutions often lack the willingness to invest in remote care as a result of their existing culture and uncertainty regarding the benefits. A working business model can be built if health care providers are subsidized for using demonstrated-to-be-cost-effective remote care applications. Dutch patients traditionally have a low individual willingness to pay for health care services, but this can be changed if those services are bundled with services aimed at safety, social care, entertainment and advertising through a low-cost infrastructure. To make remote care work it has to be successfully implemented in existing health care organizations. Applications need to be adapted to the structure of the organization, its technological systems and especially its work processes. From an HR point of view, champions need to be identified and future users have to be involved in defining the new services in order to create trust. Poor implementation results in user resistance, persistence of redundant work processes and system conflicts, hampering the realization of economic benefits. If remote care is to contribute to the macro capacity problem of the Dutch health care system, it needs to be implemented on a wide scale. Certain aspects of an innovation and of the channels through which it is communicated further the diffusion of that innovation. Two major success factors of an innovation are its relative advantage and its trialability. Communication channels built on existing social networks are superior to those that have yet to be developed. Visibility of the new application’s strengths is a condition for its adoption. Finally, diffusion is more effectively achieved if decisions are made collectively or on authority, as opposed to optional decision-making by individual user institutions. Remote care can significantly contribute to increasing the efficiency of chronic care and in doing so help to lower the cost of the Dutch health care system. This requires a well-considered strategy. Someone must take the initiative to enable a sustainable business model.
Item Type:Essay (Master)
Clients:
PricewaterhouseCoopers
Faculty:BMS: Behavioural, Management and Social Sciences
Subject:85 business administration, organizational science
Programme:Industrial Engineering and Management MSc (60029)
Link to this item:http://purl.utwente.nl/essays/60432
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