Less rules, more care

How a small country is a leading example in the world of healthcare. Buurtzorg, one of the Netherlands’ largest home care organizations, is exporting its healthcare model all across the world. Thousands of patients in China and Japan are faced with the challenge of pronouncing the Buurtzorg name. Dif travelled to England, China, and India to see how this looks in real-life situations.


Photography Otto Snoek

’30 to 40% of all costs made in the Healthcare sector are wasted.’ A statement by Buurtzorg director Jos de Blok. That provides care with 15.000 emplopyees to over 100.000 clients, with short-, long-term, or palliative care. There is little money wasted at Buurtzorg. ‘the financing of healthcare in the Netherlands isn’t focused on working as efficiently as possible. This is a problem in the rest of the world as well. That’s why Buurtzorg exports its ideas globally.’ 

Independent teams

The setup of Buurtzorg is simple. There is no management present in the organization. In the Netherlands there are about 1300 independent teams, each made up from 8 to 12 people without a teamleader. They solve problems through communication. At the head office there is a team of fifty people who mainly concern themselves with the question of how to lighten the workload of the teams. An almost completely automated system to conform to all the rules in the Dutch healthcare system. All nurses and caretakers have an iPad and a ingenious softwaresystem which takes care of all the boring menial tasks.

The person as the center

Where Buurtzorg really differentiates itself is that it doesn’t operate within the classical healthcare model. The person (client) and their surroundings are central. The health care plan isn’t just a combination of medical and domestic tasks, but rather a plan that helps the client solve problems with the help of their family, neighbours, and friends. They look at what the client is still capable of. What help can easily be found in their circle, and in which areas do they require aid? Because it isn’t just medicine and support stockings that cure someone, but also attention and love. Buurtzorg also focuses on prevention. A healthy diet, more active lifestyle, and changing unhealthy habits all contribute to preventing illness and therefore a need for care. This is a major focus for the healthcare professionals from Buurtzorg.

Expanding abroad

Jos de Blok and Gonnie Kronenberg started with a small team in the east of the Netherlands, 10 year ago. Jos as a nurse and director and Gonnie as an expert for the back office. Enthousiastic nurses, who were done with the bureaucracy that surrounded other big healthcare companies, started working for Buurtzorg, within 5 years that number rose to 3500, and with 10 years that number grew to 15.000 nurses and aides in healthcare. 

Foreign health care institutions started asking Jos de Blok to come and talk about his company and the system behind it. That laid the foundation 5 years ago to expand the Buurtzorg concept to other countries, in this case Japan.


There are many perverse things everywhere, in all systems

When you sit across Jos de Blok, you don’t really get the impression that you’re across from a CEO of a company with nearly half a billion revenue. No suits or ties for this softhearted man who you can almost always find with a smile on his face. But when he starts talking you can see the fire behind his eyes of someone who is sure he has the solution to reform the healthcare system. And when you finish that conversation one and a half hours later, you’ll believe that too.

Jos: ‘The biggest problem which a healthcare professional faces is regulation. This leads to people no longer looking at how a patient can be helped most effectively. That’s why a care plan is adapted to the regulation. That makes sure it starts being about money rather than the person, the patient. It leads to unnecessary treatments. 40% of care provided in hospitals could just as well be provided from home.’

‘Making money within healthcare is simple. It’s so subjective that you can make a care plan however you’d like. A practitioner “is invited” to word his application in such a way that he has access to as much budget as possible. This needs to change. There are many perverse things everywhere, in all systems, and this leads to healthcare becoming unaffordable.’

‘If a specialist of psychiatrist needs to make a diagnosis for instance, they’ll then look at what elements he needs in the care plan, regardless of whether the patient needs it, to get compensated enough.’

‘This isn’t just a problem for the Netherlands or western Europe. It’s a global issue’

‘The major problem is money and people. Our population is increasing and therefore our need for healthcare as well. You need to try to use the same resources to reach the same standard to quality. The investment needs to be limited, but quality needs to still be ensured. Which is certainly possible if you adapt regulation.’

‘This isn’t just a problem for the Netherlands or western Europe. It’s a global issue. Look at China for instance. They’ve decided everyone above a certain age has access to care, whether they need it or not. That leads to a huge amount of waste. We approach each country differently to see what we can do within the local culture and regulation. In china only 25% of the people are insured. If you don’t have insurance and end up in a hospital you’ll be outside again in no time. In China we started with people who needed long term care. We are trying to shift the institutional care (hospitals and nursing homes), to home care, that’s our initial focus.

‘In India we’re working together with a company that focuses on education. We take girls from villages, who we train to be caretakers or nurses. This way we provide a social impact for women and their families. In those villages there are very few trained nurses, and those who are work in hospitals.’

‘In England we stated to integrate the existing system of the National Health Service (free care for all), into the Buurtzorg model. And that’s starting to take hold. At a congress in October the English Secretary of State for Health and Social Care, Matt Hancock, stated that he was charmed by the Buurtzorg model. He said that the moment had come to take the Dutch healthcare model and integrate it on a national level’

Sign-up for our newsletter!

I have read and agree to the terms & condition