Not much care remains in this Healthcare Agreement

The NOS and the NRC messages not positive about the concept of the Integrated Care Agreement, which was drawn up by the Ministry of Health, Welfare and Sport in collaboration with all kinds of interest groups in healthcare. It looks like a major stripping of care, argues Bart Collard.

The NOS reports: ‘According to health economists, the agreement will inevitably lead to a cutback in care for the elderly.’ For example, there would be a ‘broader strategy’ that focuses on limiting the influx of patients. But if people need care, then they should get it, right? Why then does the ministry not advocate an increase in the number of healthcare workers? In the words of the NOS: ‘The cabinet does not want even more people to work in care in the future than is currently the case. Care must be prevented from stealing, as it were, scarce personnel from other sectors.’

Chat with a ‘bot’

That is why the ministry wants to ‘slow down the demand for care’. One of the options for limiting the demand for care is the digitization of care. You may soon no longer call the GP assistant, but chat with a so-called bone. In the words of the NRC: ‘In the coming years, people who are ill will more often have to rely on themselves.’ The NRC states that there will be 80 million euros less budget for general practitioners and 600 million euros less for district nurses: ‘Money that was intended for the sector in recent years, but remained on the shelf with health insurers.’

Is ‘alternative care’ being addressed?

The NOS article also mentions an apparently more positive development in the inhibition of care. Minister Ernst Kuipers would like to see medical treatments ‘that scientifically demonstrably do not meet the quality requirements or are ineffective (…) from the basic package of care reimbursed by the health insurer’. That sounds like an end to the many so-called alternative care providers and charlatans that Dutch citizens are now paying for. Or does the minister not dare to burn his fingers on that?

According to the NOS, it is about the question ‘what care you receive from the general practitioner, the hospital, the emergency department and the GGZ’. That doesn’t sound like the alternative care circuit is going to be tackled. And that while health insurers should not reimburse alternative medicine. Not in the basic package, not in additional packages.

‘Alternative’ is a pseudonym for ‘not scientifically substantiated’. This therefore concerns treatments that cost money, usually do not work and in the worst case lead to more medical care due to adverse effects. That is not what the ministry aims to do when it wants to limit care. How does the ministry intend to further test which care can be curbed? ‘Treatments that are labour-intensive, cost a lot of money and have a major impact on the climate and the environment are the first to be tested. If the care does not pass that test, it will be removed from the basic package.’

Sobering care is a choice

Professor of Economics of Public Health at the University of Groningen Jochen Mierau states: ‘In order to be able to provide long-term care to the elderly at all, we may have to consciously lower the quality of care.’ So the quality of care will have to fall even further than it already is? Who doesn’t know older people who are tucked away in care homes that hardly look better than prisons? Who is not familiar with the phenomenon that the doctor asks you what you think is wrong and then advises you to take a look?

Xander Koolman, health economist at the Free University, confirms Mierau’s image: ‘But citizens must become aware of this vision of the future. A country spends the money on care that it can spare and not what the population actually needs.’ Is it about what the government can or wants to miss? There is an important difference between them. Capacity is often a matter of priority.

Future care is in jeopardy

It is also becoming increasingly difficult to use the free choice of doctors. Non-contracted care is likely to become more expensive. After all, health insurers would like to work with providers with whom they have contracts. In addition, since 2002, ambulances must be able to reach a hospital within 45 minutes from all places where people live. Minister Kuipers also wants to strip that care, because according to him the standard is ‘not medically substantiated’, the report said NRC.

It is fine to take a critical look at people who claim the care sector on a daily or weekly basis, but who actually do not need care. In addition, it seems to be a good thing to no longer reimburse treatments from alternative medicine. After all, why should you pay more because someone else wants to consult a charlatan?

There is not enough staff in emergency care, but more people are not allowed to work in care. Anyone reading about the concept of the Integrated Care Agreement can only conclude that the future of the Dutch healthcare sector is in doubt and that the Ministry of Health, Welfare and Sport appears to be carrying out a cutbacks order above all. We are waiting for the final agreement, but the draft version is not positive.

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