Critics of market forces in health care are increasingly resonating. It was first the opposition and especially the SP that consistently criticized this, recently Minister De Jonge of Health and chairman Marian Kaljouw of the Dutch Healthcare Authority also expressed themselves critically. The corona crisis acts as a catalyst in this.
Ten days later, NZa chairman Kaljouw stated in NRC Handelsblad that “healthcare has become too much of a revenue model”. According to her, the corona crisis makes it clear that there is a lot of “nonsensical concern”. “We have to see how we can turn that around, that we are less focused on production, but do what is necessary.”
In professional magazine Care vision two parties admit that care is indeed provided that adds nothing to patients. Jan Hazelzet is professor of quality of care at Erasmus MC and Nico van Weert coordinates the Quality of Care consortium of the Dutch Federation of University Medical Centers (NFU).
But distinguishing between “valuable and worthless” care is impossible without a thorough analysis of the course and consequences of diseases in groups of patients and without taking into account what patients think and want, they write.
In a book Recently published by the NFU, there are examples of care innovations that improve patient care, stop unnecessary care and deliver savings. In practice, however, it is not easy to actually introduce an innovation that has been proven to work if the income of doctors and hospitals decreases as a result.
Operation successful, patient died
For example, it was the practice in the UMCG in Groningen for older cancer patients that doctors follow guidelines during treatment. If the patient meets the criteria for surgery, surgery will be performed. Until a young surgeon experienced a case of surgery successful, patient died.
The guidelines prescribed surgery and it was successful. The patient then temporarily went to a nursing home for rehabilitation, where he died of pneumonia. He had always lived with his brother and had COPD. He had not been told that pneumonia is no exception after such surgery, and according to his brother, it might otherwise have been a reason to opt out.
Since then, a thorough preparation with the patient about the possible impact of an operation has been held with a patient over the age of 70 before cancer surgery. As a result of this approach, the number of cancer operations among the over-70s fell by more than a quarter.
In Radboud university medical center in Nijmegen, many treatments take place according to so-called care paths with a fixed pattern. The care for patients with tumors of the stomach, intestine, liver, pancreas and esophagus has recently been reorganized, with much input from the primary stakeholders, the patients.
They used to follow a set route after their diagnosis, now they can pause their treatment or skip a step, for example to recover from chemotherapy and radiation before an operation.
Referral aid rheumatism
Rheumatologist Angelique Weel of the Maasstad Hospital in Rotterdam developed a referral together with GP Adrie Evertse from Oud-Beijerland. This app makes it easier for GPs to determine whether a patient with muscle or joint complaints should be referred.