The healthcare in The Netherlands is being trapped

It will have escaped few people. In healthcare, a "Comprehensive Care Agreement" has been agreed upon under the leadership of the minister, with the aim of saving access to care. There is a wide recognition that the current way in which healthcare is organized is inadequate for the rapidly increasing demand for care. Nevertheless, the current relationships are extremely rigid. I notice that many people consider this a natural phenomenon. "Changing healthcare is difficult, always has been." Healthcare is indeed institutionally rigid. But it does not have to be as inert as it is now. In the last ten years that I have been a hospital administrator, I have seen healthcare become trapped, after a more agile period before it. Some of that momentum can return. - Jeroen van Roon.

Jeroen van Roon
'Healthcare is indeed institutionally rigid. But it does not have to be as inert as it is now.'

The implementation of the Health Insurance Law

In the period 2005-2015, the mood was different. The Health Insurance Law was introduced. Health insurers became "selective healthcare buyers." The so-called "construction regime" was abolished. Healthcare institutions became responsible for their investment decisions. Work was being done towards a "national switchboard," with the aim of creating a national IT platform for data transfer. With a "Profit Distribution Law," they wanted to attract risk-bearing private capital that would enable healthcare to innovate and adapt.

The reasons for doing this were not much different from those of the Comprehensive Care Agreement now. Even then, we knew that the labor market would seriously fall short when accelerating aging (now).

All these steps led to a wave of new entrants such as Independent Treatment Centers, higher-quality infrastructure with more ICT, and to the next wave of hospital mergers. "Behind the front door" of those mergers, unprofitable departments and locations were sanitized and medical professionals could organize more effective teams.

Causes of the health care issues

All of these major movements were stifled in recent years. The credit crisis made banks more selective. In addition, the Upper House stopped both the Profit Distribution Law and the National Switchboard. The ACM curtailed the wave of hospital mergers. And as the icing on the cake, hospital bankruptcies increased. The whole of the Netherlands decided: we don't want that and we need to exclude all risks.

That trend is well understood. But the net result is that healthcare has become trapped. Individual initiative is hardly possible anymore. Taking risks, "not done." Healthcare entrepreneurship is suspect. A healthcare institution with an innovative concept that could potentially lead to a shift in patient flows quickly receives the indignation of other healthcare institutions. The current legal framework makes collaboration between different types of healthcare institutions very difficult. Actors in this impasse do not dare to step outside the strict interpretation of their role, knowing that "putting on big pants" causes trouble.

'Mergers do not only lead to more bureaucracy. Entrepreneurship also brings innovation.'

Regional health care plans

Against this background, healthcare is now moving to create "regional care plans," one of the main objectives of the IZA. Now that no one can or is allowed to break the current setting, it can only be done "together." Under the current circumstances, we must make a success of it. The water is already up to our lips. The IZA also offers points of contact for real change.

However, let's also look to see if we can restore some of the dynamics we had at the beginning of the decade. Yes, it was probably too fast at the time. But the total of all the restraining reactions to it was an overreaction. Mergers do not only lead to more bureaucracy. Entrepreneurship also brings innovation. Individual healthcare-improving initiatives should have a structural reward, not just a temporary subsidy. We have now wasted crucial years in which we should have prepared for the healthcare demand tsunami that is coming to us.

Problems for the citizen and health care worker

The citizen and the healthcare worker are already paying for this. The healthcare worker because in his perception it is increasingly difficult to provide good care, with all the frustration that entails. The citizen because they receive care that is less than it could have been. Or worse, when the citizen depends on it, it simply isn't there.

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Jeroen van Roon has been a hospital administrator for ten years at RKZ, OLVG and RHG. He is now focused on facilitating regional organizational ties in healthcare, for innovative care forms.