The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 5.120 (2020 JCR, received in June 2021)
Met het Nationaal Preventieakkoord beogen het kabinet en ruim zeventig organisaties de volksgezondheid te verbeteren door te focussen op roken, overgewicht en alcohol. Er zijn daarnaast ook op andere preventiethema’s nog vele mogelijkheden om tegen acceptabele kosten gezondheidswinst te boeken.
Abstract Introduction In 2015, Dutch healthcare expenditure exceeded 85 billion euros. But what about prevention? In this study we estimated national expenditure on prevention. A distinction was made between health protection, health promotion and disease prevention. In the estimation of prevention expenditures, this study is limited to universal, selective and indicated prevention, as healthcare-related prevention can hardly be distinguished from curative care. This study analyzed expenditure on preventive activities in the Netherlands in 2015 and took a societal perspective. Methods We used various sources to investigate spending on prevention in 2015. Insofar as costs were part of healthcare expenditure, estimates were based on the Care Accounts of Statistics Netherlands. For the remainder, we estimated expenditure using annual reports and annual accounts of governments and other organizations. We included preventive activities by consumers, industry, NGOs, insurance companies, and government. Results In 2015, an estimated € 12.4 billion (1.8% of the GDP) was spent on prevention: € 2.4 billion on disease prevention (19%), € 0.6 billion on health promotion (5%) and € 9.4 billion on health protection (76%). This is a decrease of 17% compared to 2007, the last year that a similar estimate was made. Within health promotion, the largest expenditure was for working conditions and safety: € 160 million. € 67 million was spent on mental disorders. The largest expenditure item within disease prevention was dental care: € 675 million. Within health protection, this was the sewer by more than € 3 billion. Conclusions Spending on prevention is relatively low compared to total spending on healthcare. The largest part is targeted at health protection. In the coming years there may be an increase in expenditure, due to more governmental prevention policies such as the National Prevention Agreement. Key messages Spending on prevention is relatively low compared to total spending on healthcare. Relatively little money for health protection.
Introduction: Integrated care for older adults living at home aims to provide holistic, multidisciplinary and person-centered care. One of the services provided in several integrated care programs is the comprehensive geriatric assessment (CGA), conducted to identify older adults’ care needs. There are many different ways to conduct a CGA. However, it is still unclear what distinguishes these CGAs from each other. Also, it is yet unknown to what extent the principles of integrated care (holism, multidisciplinarity and person-centredness) are reflected in CGAs. The objectives of this study were to: 1) compare different CGAs conducted within integrated care programs for older adults living at home, and 2) describe how the principles of integrated care were applied in these CGAs. Methods: A systematic literature search was conducted to identify integrated care programs including a CGA. Data were extracted on main characteristics of identified CGA tools and procedures, and how principles of integrated care were applied in these CGAs. Results: Twenty-six programs were included in this study, of which most were implemented in the Netherlands and the U.S. Twenty different CGA tools and procedures were identified. The majority of CGAs aimed to have a holistic, multidisciplinary and person-centred approach, although the way and extent to which CGAs incorporated these principles differed. Discussion: This systematic review highlights the variability of CGAs used in integrated care for older people living at home. The overview of CGAs may promote further exchange of CGA tools and procedures, and help researchers and professionals to not reinvent the wheel.
Synopsis Bariatric surgery appears to be a cost-effective intervention for moderately to severely obese people compared to single lifestyle interventions. This appears from a review of the literature on cost-effectiveness of bariatric surgery. Almost all studies included lifestyle advice before and after the surgery. Surgery for morbid obesity led to weight loss, which reduced the risk of complications and hence resulted in a gain of quality adjusted life years and lower healthcare costs. In groups of patients with high obesity-related healthcare costs, like patients with type 2 diabetes, the use of bariatric surgery may save money within a relatively short period of time. The RIVM has provided a review of studies on the cost-effectiveness of bariatric surgery published between 2006 and 2012. The lack of clear definitions of lifestyle advices applied to patients in the intervention and control group in many studies hampered a full comparison of selected interventions in this review. Most studies were based on at most 12 months follow-up and assumed weight loss to remain constant after this period. Moreover, information on longterm complications was lacking. Future cost-utility studies should include long-term data on resource use, sustainability of the reduction in Body Mass Index, and incidence of late complications of bariatric surgery. Also they should take a societal perspective when relevant and include productivity losses. Finally it seems essential to include the additional lifestyle advice provided in the studies also in daily practice, since otherwise it is quite probable that cost-effectiveness in reality will be less favourable than found in the literature. Obesity and its co-morbidities are a major public health and economic concern. In the Netherlands, surgery has been used increasingly in the treatment of morbid obesity, during the past 20 years. The aim of the current review was to evaluate the cost-utility of bariatric surgery using different techniques (e.g. gastric bypass and gastric banding) compared to care as usual.
In de top drie van meest voorkomende kankers staat dikkedarmkanker op de derde plaats bij mannen en op de tweede plaats bij vrouwen. Dankzij een multidisciplinaire aanpak is de prognose vandaag duidelijk verbeterd: na 5 jaar is 60 tot 70 % van de patiënten nog in leven. Belangrijk bij deze aanpak zijn de zorg voor, tijdens en na de operatie en een behandeling op maat (personalised care). Deze vaststellingen staan in de geactualiseerde richtlijnen die het Federaal Kenniscentrum voor de Gezondheidszorg (KCE) samen met het College voor Oncologie en het Integraal Kankercentrum Nederland (IKNL) ontwikkelde.
