“Primary Care Plus” in the Netherlands: Ecosystem Care Integration from a Socio-Technical Perspective

Abstract

In the Netherlands, the affordability and accessibility of healthcare is at stake. A fundamental change in the historically fragmented and poorly performing healthcare landscape is needed. With their ‘right care in the right place’ initiative the government is trying to extinguish a major cause of that fragmentation—the deeply embedded distinction between primary and hospital care. In partial response, partnerships are evolving among regional care ecosystem actors to improve care delivery. Primary Care Plus (PC+) is one of many such initiatives and involves the integration of medical specialists, traditionally within hospitals, into the domain of primary care. This chapter describes the design of three such PC+ initiatives. We apply the Socio-Technical perspective to gain insights for further development of the PC+ concept and the designing of integrated care ecosystems. By ecosystem we mean all the organizations, networks and inhabitants in a region who individually or together, directly support preventative activities, diagnosis, treatment and ongoing guidance for low-complexity patients and people with a chronic disease—including of course, the patients themselves. By a Socio-Technical perspective we mean the lens showing how the organizing (or design) of care delivery influences cost, quality and patient experience, as well as the work life experience of the care professionals (i.e. the quadruple aim).