Perspectives of Syrian Refugees on Antibiotic Use and Prescribing in Dutch Primary Care: A Qualitative Study

Background: Antibiotic resistance is an international public health concern. Medical culture influences antibiotic use. Migrants, like Syrian refugees, are confronted with a different health care system in their new country and also with different culture regarding antibiotic prescription. The aim of this study is to get insight into the perspectives, knowledge and practices among Syrian refugees regarding antibiotic use and prescribing in Dutch primary care.Methods: A qualitative study using semi-structured interviews with 12 Syrian refugees living in the Netherlands was conducted. Results: participants stressed the easy access to antibiotics in Syria and reported storing antibiotics at home for emergencies. In the Netherlands, some of them still self-prescribed antibiotics while others adhered to the Dutch GP’s advice. Syrian refugees believed in having a weaker immunity compared to the Dutch inhabitants. For their young children, they adhered to the new health care system which resulted in not giving the children antibiotics without a prescription. Several complaints about the Dutch health care system were identified such as difficult access to the desired medication and lack of medical care for their complaints. Most respondents preferred the Syrian health care system.Conclusion: Syrian refugees experienced restricted access to antibiotics in Dutch primary care which was contrary to their experiences in Syria. As a reaction, they continued self-medicating with antibiotics. However, some of them adapted to the Dutch health care culture and accepted the alternative treatment proposal. For their children most participants adhered to the prescription policy of antibiotics in the Netherlands.

Age-related difference in health care use and costs of patients with chronic kidney disease and matched controls: analysis of Dutch health care claims data

Background The financial burden of chronic kidney disease (CKD) is increasing due to the ageing population and increased prevalence of comorbid diseases. Our aim was to evaluate age-related differences in health care use and costs in Stage G4/G5 CKD without renal replacement therapy (RRT), dialysis and kidney transplant patients and compare them to the general population. Methods Using Dutch health care claims, we identified CKD patients and divided them into three groups: CKD Stage G4/G5 without RRT, dialysis and kidney transplantation. We matched them with two controls per patient. Total health care costs and hospital costs unrelated to CKD treatment are presented in four age categories (19–44, 45–64, 65–74 and ≥75 years). Results Overall, health care costs of CKD patients ≥75 years of age were lower than costs of patients 65–74 years of age. In dialysis patients, costs were highest in patients 45–64 years of age. Since costs of controls increased gradually with age, the cost ratio of patients versus controls was highest in young patients (19–44 years). CKD patients were in greater need of additional specialist care than the general population, which was already evident in young patients. Conclusion Already at a young age and in the earlier stages of CKD, patients are in need of additional care with corresponding health care costs far exceeding those of the general population. In contrast to the general population, the oldest patients (≥75 years) of all CKD patient groups have lower costs than patients 65–74 years of age, which is largely explained by lower hospital and medication costs.

Does managed competition constrain hospitals' contract prices? Evidence from the Netherlands

In the Dutch health care system, health insurers negotiate with hospitals about the pricing of hospital products in a managed competition framework. In this paper, we study these contract prices that became for the first time publicly available in 2016. The data show substantive price variation between hospitals for the same products, and within a hospital for the same product across insurers. About 27% of the contract prices for a hospital product are at least 20% higher or lower than the average contract price in the market. For about half of the products, the highest and the lowest contract prices across hospitals differ by a factor of three or more. Moreover, hospital product prices do not follow a consistent ranking across hospitals, suggesting substantial cross-subsidization between hospital products. Potential explanations for the large and seemingly random price variation are: (i) different cost pricing methods used by hospitals, (ii) uncertainty due to frequent changes in the hospital payment system, (iii) price adjustments related to negotiated lumpsum payments and (iv) differences in hospital and insurer market power. Several policy options are discussed to reduce variation and increase transparency of hospital prices.