[More focus on prevention in the health care system? Acknowledge the need for a programmatic approach].

Objective: A sustainable healthcare system calls for strengthening the focus on prevention. In general, there is no articulated demand for preventive interventions by an individual. Prevention therefore requires a programmatic approach. Based on an empirical analysis of primary and secondary prevention in our healthcare system, we identify crucial elements of such an approach.

Design: Desk research METHOD: The online publication is based on 41 preventive interventions that, according to US guidelines for adults, certainly will (grade A) or are very likely (grade B) to improve health. We investigated whether these interventions were implemented in a similar manner in clinical or public health practice in the Netherlands, and how these interventions are organized, implemented and funded.

Results: In the US, a systematic approach for disease prevention is recommended for 15 drug or behavioural interventions. In the Netherlands, six of these (e.g. counselling excessive alcohol consumption) are offered only to patients who present themselves with complaints or questions. In the US, systematic early detection is recommended for 26 diseases. In the Netherlands, for eleven of those, no early detection programme has been implemented (e.g. hypertension). In the Netherlands, all interventions have a basis for funding.

Conclusion: Firstly, it is recommended that consensus will be reached in the Netherlands about which preventive interventions should be systematically offered to whom. Secondly, strengthening prevention implies the systematic identification of those who might benefit from interventions, especially in case of drug and behavioural ones. Thirdly, our analysis points to the importance of funding that aligns with a programmatic approach.