This incongruity led to a further step, namely the abolishment of the fee-for-service system for the specialists. Since last year almost all specialisty groups receive a fixed lump-sum. This means that, as a group, they do not gain anymore by a high level of production. Within the specialty partnership, however, there is still freedom to pay specialists according to their level of production. In this way the government gradually diminishes the relationship between income and production of specialists. Although the specialists claim that patient care deteriorates, it looks as if this situation won't change shortly, so they have to put up with it. Nowadays the most common way to try and control the budget is to install management teams, consisting of medical specialists, nurses and administrators. In my hospital this way of organization will be introduced in 1998.
Screen 32 (hospital care trends)
Hospital care is a relatively expensive form of care. This is a large part of the explanation of two trends that are common within the hospital care system the last few years: 1. The reduction of the total number of hospital beds; 2. Substitution of inpatient care to outpatient departments, to day care and also to home care.
Screen 33 (Hospital care: reduction of hospital beds)
The trend to reduce the number of hospital beds started in 1975. Since that year the total number of beds per inhabitant has decreased gradually. In 1975 the official standard for hospital beds was lowered from 5 to 4 beds per 1.000 inhabitants. This standard was gradually brought down to 3.7, then to 3.4 and now even to 2.8. Plans exist to lower the number of beds per 1000 inhabitants to 2.0 which is an absolute minimum in the trend. On the screen you see
