The Dutch experience: reciprocal influences between (socio-)political processes and casemix systems

Introduction The Dutch DBC-system was developed and implemented between 2000 and 2005. When compared to other members of the 'classification family tree' it can be concluded that the system is not a logical step in the general line of development of classification systems. On a number of characteristics the Dutch system stands out from the other systems. One major differing characteristic being the fact that the system is not based on an internationally recognised classification system, but on 24 different systems of diagnosis classification, developed by different specialist medical associations. This results in 24 product structures that cannot be compared amongst each other. Another main difference with 'classical DRG-systems' is the episode of care rather than the encounter as a basis of the DBC-product. In the presentation we will investigate into the underlying political process that led to the creation of a deviant system. We will highlight some benefits of the system, but will also point out the fundamental changes that are needed to combine the benefits of the DBC with the benefits of DRG-systems. We will conclude with some assumptions on how the fundamental changes will reciprocally influence the socio-political relations in the Dutch health landscape.