New models of care: Focusing on substitution of hospital care with primary care. Trend setting or trend breaking

This dissertation describes the research into two substitution initiatives implemented in two pioneer sites located in the province of Limburg, in the south of the Netherlands. The first initiative are the Primary Care Plus (PC+) centres implemented in the pioneer site "Blue Care" located in the Maastricht-Heuvelland region, focusing on medical specialists providing consultations in a primary care setting. The second initiative is the care pathway ‘Better exercise in osteoarthritis’ implemented in pioneer site ‘Differently Better’ located in the Western Mining District. Part I of this dissertation presented several studies conducted to examine the influence of the implementation of PC+ and the care pathway ‘Better exercise in osteoarthritis’ on the referral behaviour from primary to secondary care and the request of diagnostic imaging. Part II of this dissertation consisted of several studies examining the effect of PC+ on the health-related quality of patients, the perceived quality of care, the cost-effectiveness and the care volume at regional level.