Give more responsibility to the patient instead of to the institutions

Inspiration and suggestions for a new care model

Svin Deneckere

Svin Deneckere - Director of the Flemish Institute for Quality of Care(VIKZ)

Experts throughout the world agree: health care must evolve into a new model, whereby it is not the care institutions that take centre stage, but the person with a request for care. That changes the classic view of medical treatment. The traditional approach is replaced by a multidisciplinary approach in which the quality of care and life have a central position, and which is more focused on prevention and the promotion of healthy living.

Quality assurance is crucial in this. That is the expertise of Svin Deneckere, director of the Flemish Institute for Quality of Care (VIKZ). The aim of VIKZ is to make the quality of care measurable, so that both the care provider, the authorities and the patient can see where there are points for improvement, says Svin. “We support the care & health sector in Flanders to develop these quality measurements, and to report the results to the public on our website After all, the citizen must be able to find out where he can find the best quality of care for his problem. In this way, the quality of care becomes a stimulus for improvement.”

A double movement

In order to achieve the new care model, the director of the VIZK argues for a double movement of centralisation and decentralisation.

“We must be able to centralise more the highly complex care. There are still too many so-called IKEA hospitals around today, which all want to offer every form of care. That’s not at all necessary. Let us use in part the quality measurements to determine which care is best offered where, and which is not.

At the same time, we must remove the chronic care as much as possible from the highly complex environment. In other words: we must decentralise the chronic care and start organizing it in a person-centered way as much as possible, moving the focus away from hospitals, residential care centers and institutions.

"The best quality of care can also be less care."

Chronic care can be best organised at the level of society, as a preventive, neighbourhood-focused care. For example, in the area of care for the elderly, we can focus on age-friendly and dementia-friendly municipalities and on residential care areas in which you can evolve as elderly person: from your owner-occupied dwelling to co-housing, to an assisted-living dwelling and only then to a residential care centre.

This organisation is, by the way, not only possible for elderly care but also for chronic illnesses such as diabetes, backache and mental diseases such as depression. We must also be able to remove these from the care institutions and organise them on the basis of the patient’s story.


A personal budget for the patient

It is also important to organise funding differently. That is now too much based on actions: you provide care and you are paid for it. You are largely encouraged to perform many actions, and not necessarily to deliver the best quality of care. The best quality of care can, after all, also be less care, or treatment from a different care provider.

But funding based on performance remains important, for that stimulates innovation and ensures a great accessibility to care. But we must also fund quality, whereby people are encouraged to work in a multi-disciplinary way.

Personal health budgets can also prove useful for putting the patient first. These already exist in care for the disabled. Instead of giving a budget to a care institution, you give the money to the person with the disease. He or she can then use that budget to make choices and purchase care. You thus give the responsibility to the patient rather than to the institutions. That can prove a stimulus to free oneself from institution-focused thinking.


That approach must be combined with a greater focus on prevention in all its aspects. Of every 100 euros which the government spends on care, only 1 or 2 euros is currently spent on prevention. That is not logical, for studies show that you earn back each euro you invest in prevention, three to four-fold.”

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