Concentrating childhood cancer treatment in the Netherlands.

Paediatric tertiary care is highly centralized in the Netherlands. The country is small (16 million inhabitants, overall unemployment rates were approximately 7 % in 2014, while young adult (< 25 years) unemployment rates were 12 %) with the majority of the population living in Amsterdam and Rotterdam and their neighbouring cities/villages. There are 90 hospitals taking care for children in the Netherlands. Specific types of highly specialized care, such as transplantation, are provided in a maximum of three centres (kidney transplants in 3, bone marrow tranplants in 2, liver transplants in only one center), while neonatal intensive care is offered in 10 hospitals. Recently, patients with solid tumours in the thorax and abdomen were concentrated in a single centre with five university centres who provide care during the less intensive part of the treatment (in shared care). Similar changes are planned for congenital surgery, aiming for two such centres in the Netherlands. The general view of the Dutch Paediatric Association underscores the need for centralisation, while high-level care should be guaranteed at those hospitals where no specialized centre is present.