Quality Indicators in the Care Sector

The quality of care provision must be transparent. Transparency helps patients choose what care they receive, care insurers procure care and the Health Inspectorate supervise care provision. Indicators are a means to make the quality of care transparent. The Minister of Health, Welfare and Sport (VWS) is seeking a limited set of indicators that provide the greatest possible information on the outcome of care. The Court of Audit has analysed the minister's success in enhancing the transparency of care quality.


The Ministers of VWS have not adequately succeeded in increasing the transparency of the quality of care in the past 16 years so that patients can use the available information to choose a care provider and the Health Inspectorate to supervise care provision. The available information is not sufficient for care insurers to manage their care procurement adequately. Several initiatives have been taken to enhance transparency. At the end of 2012, most care sectors had agreed a common vision and all sectors had developed indicator sets. Yet our audit found that: 

  •  the stability and quality of most indicator sets to measure quality was limited;
  • few indicators had been developed to measure the outcomes of care; 
  • in the past five years, the ministers had allocated €31 million to develop indicators for the care sector. The practical value of the indicators, however, was disappointing.

We also found that parties in the field were leaving existing partnerships and forming smaller ones. This is a poor starting point for the new Quality Institution to establish professional standards and measurement instruments in the care sector.


We recommend that the Minister of VWS use the Quality Institution during the initial phase chiefly to bring the parties together again. Determine whether progress can be made in each sector by using new web functionalities. Find a better and sustainable balance between a limited number of care-based and organisational indicators and client experience.


The Minister of VWS believes the glass is half full regarding the development of care quality indicators and further measures are still required. She believes the Quality Institution will play an important role in this. She did not respond to our findings on the quality of the indicators used or the limited number of outcome indicators.