Strengths and weaknesses of the acute care systems in the United Kingdom and the Netherlands: what can we learn from each other?

Abstract

Background The demand on Emergency Departments and acute medical services is increasing internationally, creating pressure on health systems and negatively influencing the quality of delivered care. Visible consequences of the increased demand on acute services is crowding and queuing. This manifests as delays in the Emergency Departments, adverse clinical outcomes and poor patient experience. Overview Despite the similarities in the UK’s and Dutch health care systems, such as universal health coverage, there are differences in the number of patients presenting at the Emergency Departments and the burden of crowding between these countries. Given the similarities in funding, this paper explores the similarities and differences in the organisational structure of acute care in the UK and the Netherlands. In the Netherlands, less patients are seen at the ED than in England and the admission rate is higher. GPs and so-called GP-posts serve 24/7 as gatekeepers in acute care, but EDs are heterogeneously organised. In the UK, the acute care system has a number of different access points and the accessibility of GPs seems to be suboptimal. Acute ambulatory care may relieve the pressure from EDs and Acute Medical Units. In both countries the ageing population leads to a changing case mix at the ED with an increased amount of multimorbid patients with polypharmacy, requiring generalistic and multidisciplinary care. Conclusion The acute and emergency care in the Netherlands and the UK face similar challenges. We believe that each system has strengths that the other can learn from. The Netherlands may benefit from an acute ambulatory care system and the UK by optimizing the accessibility of GPs 24/7 and improving signposting for urgent care services. In both countries the changing case mix at the ED needs doctors who are superspecialists instead of subspecialists. Finally, to improve the organisation of health care, doctors need to be visible medical leaders and participate in the organisation of care.

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“…Given UK occupancy pressures, fi rstly reducing delays within acute control seems sensible, while continuing to work closely with social and community services (these are more complex to address and have major impact on costs 34 and LOS 16,17 . While undertaking a DoCS program, it is necessary to understand the healthcare system being surveyed, for example here in the UK 35 .…”

Low acuity paediatric emergency visits under single-payer universal health insurance in Taiwan, 2000–2015: a population-based repeated cross-sectional design

“…Increasing international demand for acute medical services and diagnostic rate or intervention trends in the PED may explain the need for non-LA PED services. 6 8 14 36–38 …”

“…1–5 It would be expected that the recent global movement towards expansion of health insurance coverage would result in improved access to primary care or preventative services, thus reducing hospital ED visits. However, other studies have suggested the opposite may occur, 6–10 where the expansion and comprehensiveness of health insurance coverage may, on the other hand, increase the utilisation of hospital ED. 11–14 Due to the pervasive phenomenon of moral hazard in health insurance, whether comprehensive health insurance coverage may exacerbate potentially unnecessary ED utilisation has become a critical policy concern.…”

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