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Open Access Debate

The Dutch Consumer Quality Index: an example of stakeholder involvement in indicator development

Diana MJ Delnoij12*, Jany JDJM Rademakers3 and Peter P Groenewegen34

Author Affiliations

1 Centre for Consumer Experience in Healthcare (Centrum Klantervaring Zorg). PO Box 1568, 3500 BN Utrecht, the Netherlands

2 TRANZO (Scientific Centre for Care and Welfare), Faculty of Social and Behavioural Sciences, Tilburg University, PO Box 90153, 5000 LE Tilburg, the Netherlands

3 NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, the Netherlands

4 Utrecht University, Department of Human Geography, Department of Sociology, PO Box 90115, 3508 TC Utrecht, the Netherlands

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BMC Health Services Research 2010, 10:88  doi:10.1186/1472-6963-10-88

Published: 6 April 2010



Like in several other Western countries, in the Dutch health care system regulated competition has been introduced. In order to make this work, comparable information is required about the performance of health care providers in terms of effectiveness, safety and patient experiences. Without further coordination, external actors will all try to force health care providers to be transparent. For health care providers this might result in a situation in which they have to deliver data for several sets of indicators, defined by different actors. Therefore, in the Netherlands an effort is made to define national sets of performance indicators and related measuring instruments. In this article, the following questions are addressed, using patient experiences as an example:

- When and how are stakeholders involved in the development of indicators and instruments that measure the patients' experiences with health care providers?

- Does this involvement lead to indicators and instruments that match stakeholders' information needs?


The Dutch experiences show that it is possible to implement national indicator sets and to reach consensus about what needs to be measured. Preliminary evaluations show that for health care providers and health insurers the benefits of standardization outweigh the possible loss of tailor-made information. However, it has also become clear that particular attention should be given to the participation of patient/consumer organisations.


Stakeholder involvement is complex and time-consuming. However, it is the only way to balance the information needs of all the parties that ask for and benefit from transparency, without frustrating the health care system.