Prevention in the curative sector

The primary mission of the curative sector is obviously to cure, but prevention belongs explicitly to one of its tasks as well. Some forms of prevention can easily be organised outside the curative sector. However, for other forms it may be optimal to combine cure and prevention in one entity. Doctors have a lot of information about their patients, their medical history, etc. Furthermore, they meet their patients relatively often (Dutch general practitioners see three-quarters of their patients at least once a year). Doctors are in a favourable position to provide adequate and effective preventive care. But at the same time we know that the incentives in the curative sector are not geared at prevention. This is true for health insurers as well as doctors. Recent changes in the Dutch system of health insurance may worsen the incentives further.

Therefore, this paper concentrates on prevention within the health care sector. In the analysis of prevention in the curative sector the emphasis is on the role of the general practitioner (GP).

The ambition of this study is to answer the three following questions:

1. What is the extent of prevention in the curative sector? (Part 2)
2. Is there currently too little prevention in the curative sector? (Part 3)
3. Why does the curative sector fail to provide enough preventive care? (Part 4)

We discuss some policy options that might stimulate prevention in the curative sector. We discuss the experience of other countries and draw lessons for the Netherlands.