Public SPACE is an initiative of Boer & Croon Strategy and Management Group. This report is solely for the use of our clients. No part of it may be circulated, quoted, or reproduced for distribution outside the client organization without prior written approval from Public SPACE. Private incentives within and privatization of (mental) health care A framework for the debate Delivered at invitational conference Mental Health Care Providers Association of the Netherlands Amsterdam/Eerbeek, 3 December 2002 S.P.M. de Waal Partner Boer & Croon/Public SPACE

1 0.1/SWA/GGZ NL   Much legislation, little formal room for private initiative   Bureaucratic planning of standardized supply, independent of demand   Stringent and scarce due to non-care policies (tax burden)   Sector itself very collectively organized Disappearance of citizen’s trust Demotivation of employees Slow progress of system changes New policy is ‘too little, too late’ Current Steering in Care (Netherlands)

2 0.1/SWA/GGZ NL Current Care Steering Actual purchasing power increases and ‘leaks’ beyond public scarcity: Pensions Employers Buying power of citizens and their priorities Modern patient wants another type of care (consumerism) Health Care is not just cost, but also investing: Economic development Prevention Competition on the job market is cutthroat Public funding and national planning will never allow for all demands (volume, customized, speed, community effectiveness) Strong Forces Press upon this System

3 0.1/SWA/GGZ NL Big Political Choices Needed Funding Ownership Only state- owned State/private organizations Only private organizations Only public Public/private Only private   Profit and/or non-profit: difference?   Competition or planning & monopolies   Concession criteria and inspection and good governance   European regulation on open market   Voucher systems   Separation of infra- structure and care production   Compensation for the poor/ disabled et cetera How to guarantee all basic rights in a more flexible and entrepreneurial system?

4 0.1/SWA/GGZ NL Share-holders Citizen support Civil enterprise Public funding Government organization Market income Commercial enterprise   Donations   Legacies   Volunteering   Member payments Ploughing back Financial resources Organizations The Third Model which Holland Has Successfully Built

5 0.1/SWA/GGZ NL In the Meantime There Is Much Room for Entrepreneurship… Current strategies (non- exclusive):  Corporate merging: regional monopolies, negotiating power, economies of scale and services  vertical integration  horizontal integration  Small scale and community based services  Commercial services within regional public monopoly  Services abroad Civil enterprise Government/purchaser CitizenMarket

6 0.1/SWA/GGZ NL …and for New Enterprises Current strategies  Cost cutting: easy jet health care (not very common)  Differentiation  Niche markets  National franchise formula  Focus: specializing and dedicated organization (volume AND top care) Commercial enterprise Purchaser Substitutes Consumer Regular public organization Government

7 0.1/SWA/GGZ NL Present Challenges  Value for money –efficiency –effectiveness  Chainless care  Community care  Health responsibility and prevention  Good governance  Consumer power –NGO’s –legislation and law suits –e-power  Solving public problems –addiction –forensic care –homeless –fugitives Typical policy instruments like: performance measurement output financing benchmarking neutral indication

8 0.1/SWA/GGZ NL Public SPACE is een initiatief van Boer & Croon Adviseert topmanagement over strategie en complexe organisatieverandering Boer & Croon Corporate Strategy Boer & Croon Process Managers Boer & Croon Corporate Communication Boer & Croon Executive Managers EIM Executive Interim Management NeXtrategy InterMaat Masters in Change Boer & Croon Professional Governance Academy for Young Executives Public SPACE Boer & Croon Corporate Finance + Voorziet op tijdelijke basis in ervaren en onafhankelijke eindverantwoordelijke managers Maakt communicatie op het hoogste organisatieniveau bespreekbaar, beslisbaar en verankerbaar Begeleidt fusies en samenwerkingen. Doet waardebepaling en zoekprocessen naar kandidaten en helpt bij de integratie Stuurt en begeleidt complexe veranderings- en besluitvormingsprocessen Voorziet op tijdelijke basis in veranderingsmanagers, projectmanagers en functionele managers Voorziet in voorzitters en leden van raden van commissarissen en raden van toezicht Management development programma voor jong talent Ontwerpt en implementeert internet- en e-business strategieën Joint Venture met Egon Zehnder. EIM is ons netwerk van management- en advieskantoren in Europa, de Verenigde Staten en Australië Internationaal advies- en onderzoekscentrum op het gebied van Strategies for Public And Civil Entrepreneurs Bij Boer & Croon zijn in Nederland circa 300 professionals werkzaam en in Europees verband circa 150 professionals

9 0.1/SWA/GGZ NL