In conversation with NZa chairman Marian Kaljouw

The KNMG wants to initiate a movement in which we tackle the causes of health problems where they arise. As a start, we are organizing a working conference for administrators within and outside the healthcare sector on 13 December. What solutions do they see and how do we embed them? In the run-up to this, we ask various experts to share their views on this with us.

Marian Kaljouw, chair of the Dutch Healthcare Authority (NZa), gives her vision and explains what she believes is needed to realize the KNMG’s ambition.

Marian Kaljouw

Like other organizations, the KNMG wants health to be given a more important place in a wide range of domains: from education to construction, for example. What do you think of this ambition?

“Very good. We have given that advice in the report ‘Working together on appropriate care: the future is now’, which we as the Dutch Healthcare Authority (NZa) have drawn up together with the National Health Care Institute. We look at how we can provide care that meets the needs of the patient and is available in the right place. This is under pressure due to the high demand for care. The NZa has the statutory duty to keep healthcare accessible, especially for the group that does not know the way around or has money problems. We mainly look at people who are in danger of falling overboard. For example, people who do not visit their GP because they are afraid of a referral and thus of losing their deductible. This dichotomy must be avoided. That is why more attention is needed for health, for preventive measures.”

What is needed to achieve that?

“Care is stuck. Due to unbridled supply and demand, but also due to staff shortages. If we don’t do anything about it, you won’t be able to get help as quickly. People who know their way around or earn enough money for expensive treatment elsewhere will find a way to get care quickly. But people who know less about the health care system or have a lower income have to wait longer and get sicker. Then health inequalities will increase. Do you want to do something about that? Then we must dare to make choices. Professional care is scarce. That is why we as the NZa say: if people can save themselves at home, possibly with the help of their network, then that is the first choice. And will GPs have more time for a consultation? Then they need to refer less quickly to find the cause of a complaint. We must also prevent health problems. That is why healthy behavior deserves attention. I read about a school where students start the day by running around the building. How easy can it be? Also think about healthy food at school. If the Dutch become healthier, the demand for care will decrease. Then we can better secure access for people who really need help.”

What role do you play in that?

“The NZa has a leading role. In the Integral Care Agreement, the Ministry and relevant organizations have made agreements about appropriate care this year. We monitor the implementation. With our regional analyses, we show healthcare parties in a specific area cooperation opportunities to improve health and remove bottlenecks. We then help those parties with their plans to achieve that.” “I saw a good example of this collaboration: the Platform MooiMaasvallei in the regions of North Limburg and the Land van Cuijk. A hospital, mental health care, general practitioners and dentists, long-term care and the social domain, among others, have joined forces there. Thanks to their approach, the hospital has 11,000 fewer days of admission. By working together more and taking preventive measures, you can relieve hospitals.”

What opportunities and dilemmas do you see?

“The Dutch are used to receiving care immediately if it is deemed necessary. But due to the high demand for care, you will no longer get help with every ache. I suspect that many patients do not yet realize this. In addition, the question is how to help vulnerable people. In Amsterdam-Noord, for example, the hospital has many over-75s in the emergency department. It turns out that they visit their GP an average of 40 times a year. He sends them to the hospital with heart complaints. But after further questioning it turns out that they are mainly lonely and have stress and debts. How can we help this vulnerable group and prevent them from going to the doctor?”

“Caring for the elderly is not only the responsibility of the government, but of society as a whole. How will you help that group when there is not a place for everyone in the nursing home? A colleague of mine has one tinyhouse built in the garden for her in-laws. Not everyone can afford that. The risk is that health inequalities will continue to grow. These are social discussions, for which Amsterdam-Noord, for example, has a citizens’ council. Residents talk about care and how they can help each other. As governments and healthcare organizations we have to talk to people themselves. That way we can discover good ideas.”

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