Institutional collaboration required to tackle lifestyle problems

Commissioned by the Ministry of Health, Welfare, and Sport (VWS), they conducted public administrative research into the policy formation and results of the inclusion of Gecombineerde Leefstijl Interventies (GLIs - combined lifestyle interventions) in the basic health insurance package. GLIs are healthcare prevention tracks in which the people coping with overweight and obesity endeavour to adopt a healthier lifestyle through group activities and individual guidance and assistance.

Not enough commitment

The inclusion of the GLI as a payment title should have been a coordinating tool for collaboration in the area of lifestyle prevention, but it appears that the sectors are not sufficiently funded and facilitated, which means that prevention does not gain momentum. “Citizens and enterprising innovators must be more involved during all phases and at all levels,” the researchers concluded. The coronavirus crisis has taught us that lifestyle is closely connected to health risks. Partly as a result, lifestyle prevention is put high on the agenda.

Research into policy formation

That a new approach is required is clear from the public administrative research by Wageningen University & Research. Researchers looked at the twelve years prior to the decision to accept three GLIs and to reimburse them in the basic ZVW (health insurance act) package from January 2019. From that year, the general practitioner can refer patients to lifestyle coaches, dieticians, and physiotherapists who will perform GLIs. Participants do not pay a deductible.

According to the research, policy choices show that the government viewed GLI not only as a new intervention, but also as an instrument to make the collaboration between healthcare, municipalities, and the market of physical activity coaching a standard practice. It proposed a new standard to secure prevention in healthcare. This should have made collaboration between general practitioners and lifestyle coaches and a connection between the medical and social domain a standard practice. “But it has not been sufficiently successful. There was too much adherence to the institutional environment of the health insurance act; the social domain remained underexposed,” said the researchers.

Lessons for the future

The lessons that can be drawn from the research are included verbatim in the letter to parliament addressed to the Minister of Health, Welfare, and Sport that was drafted in response to the research. This is the reason for a direct quote:

‘Collaboration between practitioners of different policy systems has insufficiently materialised as there are facilitating but no accountability incentives for the organisation of that collaboration, both at the regional and national levels. A complementary instrument is needed to bring this collaboration about.

Promoting cohesiveness between the systems not only implies a governance (coordination and management) of change, but also a change in governance, so that it becomes more focused on collaborative arrangements and learning-policy and implementation networks.

Designers and users of promising prevention interventions must play an important role during the process, just as the representatives of established healthcare parties and scientists. This will strengthen trust in the government and the implementation willingness and capacity in the field that are essential prerequisites for success.’

According to the letter to parliament, an infrastructure must be created where prevention and health promotion come first. It must include clear tasks for municipalities and healthcare providers. Collaboration must be promoted, and funding must be made structural.