The structure and dynamics of health centres in the Netherlands: an institutional analysis.

Context: Health centres are seen as a preferred organization of the modernized and integrated primary care. they are expected to facilitate an accessible contact point for medical care as close to people’s homes. Also, health centres are expected to deliver care in an efficient and effective way, minimizing the referring of patients to care and cure institutions. Methods: The population of health centres in the Netherlands is described by analysing the dynamics of (currently nearly 200) members of the Dutch branch organizations for Organized Primary Care. In addition, information is collected from their websites and yearend reports. In parallel, we reconstruct the policy and legal arrangements of the Dutch government with regard to the financial support of health centres. To explain the interaction between the behaviour of health centres and developments of the policy environment over time, we apply Porters’ five forces model and the institutional isomorphism theory. Results: Historic l analysis shows that the establishment of health centres accelerated in the seventies, then follow a much slower growth rate during the mid-eighties, and then stabilized during the nineties. During the last decade, the establishments of health centres started to grow again, but mainly due to mergers and up-scaling resulting in enlarging health centres. Towards 2000, the financial support by the government was reduced and largely discarded by the Dutch health system reform in 2006. Health centres strategically reacted by mergers and consolidation, to deal with the new power of health insurers. Discussion: The question remains whether public funding should focus on the establishment or the consolidation of new health centres. The potential value of multidisciplinary collaboration seems to develop properly in new residential areas, but its funding also disentangle with the growth of healthcare providers and recipients. Alternatively, public-private partnerships can be considered as new ways to establish integrated primary health care at district level