Substitution of care

Succesful projects on substitution of care

The costs of health care are still growing every year. One of the big challenges of hospitals board and their staff is to do more, at a high quality level, for the same amount of money.

The last decade, year after year hospitals took in extra money to pay for all services delivered. Since a couple of years we are facing a different situation. No more growth in health care expenditures. Percentage of growth in budget in 2022 will be 0%.


Because also in the future people will need hospital treatment, we are trying to get “unnecessary” care out of the hospital to make space for treatment that really needs to be given within the hospital area. I think this a global issue. We have a situation of full beds every winter period. So we try to transfer low care needs to primary care in order to have time, money and space for treatment of the patients that really need it.


For the last few years we try to make clear agreements on this subject with the primary care board of directors and the insurance companies. Unfortunately not with great success so far. I think the reason why we do not succeed is because of the money issue. The primary care doesn’t want to deliver extra care without extra money, the insurance company does not want to pay this extra amount of money, so the hospital is supposed to give the budget with this substitution of patients to primary care. Sounds logical. But in the hospital, we do not experience that less care is given to our patients. The opposite, the beds will still be filled, every year we do more intensive care procedures, we try to keep out the “easy” patients and as a consequence more “difficult” patients take in their place, which is more time consuming and more expensive. How to turn this around.


In the next few months, every 4 weeks, I will be discussing the substitution of care problem with my CEO and the board of primary care institutions in our area. We have friendly conversations, and we try to find subjects of care in which we can really meet each other in order to do something meaningful in health care in our area. But how do we make progress on the issue of substitution of care. Without overloading the primary care section, without financially damage the hospital organization. It would be helpful to have some advice or examples of successful projects on this topic.


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Participant comments on Substitution of care

  1. Hi Viv,
    from you description I get the idea that we at ErasmusMC are in a similar situation. What is not clear to me is what it is you are substituting; it reads as if you are just trying to push some kinds of care out. In some of our departments we have been successful substituting secondary care to tertiary care and deal this out with insurance companies, but this has not been easy as some departments have more possibilities for this than others.

  2. I work for an Australian organization that provides hospital substitution services in the community – and we had to (and continually have to) demonstrate the benefits to governments and hospitals (Australian public hospitals are taxpayer funded). To be honest the best success we have had is where a hospital is reaching the point where it would have to invest in new beds – and we show the cost of community based care is less than the capital cost – or where we have done some pretty interesting funding models such as a Social Impact Bond which sees us take some of the risk (ie on readmission rates eg). Perhaps you could demonstrate to your funders that you can manage growing healthcare needs at a lower cost, or delay capital expenditure by substituting home care for hospital care?

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